Case Manager Care Coordination Days Registry

Job Description

Job Description

Company Description

At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better health care, no matter where you work within the Northwestern Medicine system. We pride ourselves on providing competitive benefits : from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, our goal is to take care of our employees. Ready to join our quest for better?

Job Description

The Case Manager IHR reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

Responsibilities :

• Handles caseload of patients as determined by manager.
• Forwards assessments and clinical data to payers and external providers to facilitate transitions and payment.
• Communicates team conference and POC recommendations to patient and family and to third parties as indicated.
• Assists with facilitation of team conference to ensure that patient continues to meet LOC criteria and is progressing toward discharge goals in conjunction with interdisciplinary team.
• Works with interdisciplinary team on ensuring procurement of discharge needs for patient in terms of DME, clinical services and ongoing care to support a safe transition to an appropriate LOC.
• Facilitates family training as needed in order to support a safe transition to the next LOC.
• Assesses need for and provides referrals to community resources to support the patient safely in the community setting.
• Coordinates with patient / financial services and admissions to ensure smooth transitions between levels of care and manage concurrent denials.
• Provides ongoing education to interdisciplinary team on patients insurance benefits and status of LOS approval.
• Requests authorization for continued stay from payers as recommended by interdisciplinary team through concurrent review process.
• Coordinates appeals on any concurrent denials of requests for continued stay.
• Reviews patients progress and medical necessity for continued stay against protocol and benchmarks and communicates with attending physician and team.
• Monitors and communicates resource utilization with attending physician.
• Identifies variances from established benchmarks on cost / outcome / LOS and notify physician and team.
• Obtains authorization as required from payer for any special services or procedures.
• Case Managers in pediatrics assist with managing referrals for IRF and outpatient services as well as assists with referral development objectives.

AA / EOE.

Qualifications

Required :

Preferred :

Additional Information

Northwestern Medicine is an equal opportunity employer (disability, VETS) and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.

Background Check

Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check.  Results are evaluated on a case-by-case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.

Benefits

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.

Sign-on Bonus Eligibility :  Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign on bonus. Exception : New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family.