JOB SUMMARY –

The RN Case Manager carries out activities related to utilization management, discharge planning, and care coordination. Participates in patient care rounds and promotes interdisciplinary collaboration with all team members. ensure patient needs are met and care delivery is coordinated across the continuum at the appropriate level of care He/she clinically assesses, plans, implements, coordinates, monitors, and evaluates options and services through effective care coordination and utilization of healthcare resources in order to achieve desired clinical and financial goals.

Key responsibilities include determination of medical necessity, ability to partner with the healthcare team to ensure all aspects of the patient’s needs, clinical, psychosocial and financial are adequately addressed in the transition of care plan and to manage the patient’s timely progression of care and safe transition to the next most appropriate level of care.

QUALIFICATIONS –

• Current IL RN licensure required
• RN Degree (Bachelor’s degree preferred)
• Experience and certification in case management preferred; case management certification expected within 2 years of hire
• Experience in Utilization Management
• 5 years minimum in acute nursing experience
• BLS Required
• Current sound clinical knowledge; knowledge of medical literature, research methodology, financial/ reimbursement issues
• Strong collaboration, communication and interpersonal skills
• Excellent organizational and time management skills
• Knowledge of computers, Electronic Health Records, data base systems and utilization review/case management documentation systems
• Desire to work collaboratively and proactively with healthcare teams and other hospital-based interdisciplinary teams
• Current knowledge of discharge planning, resource management, utilization review and care coordination in an acute care setting
• Knowledge of CMS, commercial payer requirements and hospital financial/reimbursement processes
• Excellent written/verbal communication skills, critical thinking skills, creative problem-solving skills, good organizational and planning skills
• Must be self-directed, have the ability to tolerate frequent interruption and work in a fast-paced work environment
• Knowledge of funding, resources, services, clinical standards, care coordination processes and outcomes are preferred
• Weekend rotation will be required. Holiday and on call may be required