Utilization Review RN-UR Casual Rotating Shift

Utilization Review SupportThis is a casual position supporting Utilization Review at Catherine Gratz Griffin Lake Forest Hospital. This position is to provide additional staffing coverage for the department and does not have a set schedule. Looking for someone who is able to work weekdays and weekends. Scheduled for this role is 6a to 6p or 6p to 6a.The Case Manager, RN (PT) 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:Develops individualized treatment plans for patients, in collaboration with the patient, their family andCoordinates and leads care conferences on patients with length of stays greater than 7 days.Documents unusual occurrences and patient relations issues; makes appropriate referrals to risk management, infection control and quality departments.Assesses patient and family needs for appropriate discharge services.Coordinates transfer to appropriate level of care such as skilled care, rehabilitation, custodial and home health care.Documents discharge planning on the interdisciplinary plan of care, in progress notes and education record.Maintains current knowledge of resources available in the community to support a continuum of effective services for the patient.Delivers notice of Medicare discharge appeal rights within the appropriate time frame.Assists physician in assigning admission status.Performs medical record review to assess for appropriateness of admissions and continued hospital stay.Monitors avoidable days and recommends change in services or processes.Educates staff on CPG/Standing Orders/Protocols that complement industry standards to reduce length of stay and resource consumption while maintaining quality of care.Ensures compliance with managed care contracts and length of stay targets while maintaining quality of care.Develops and educates staff on CPG/Standing Orders/Protocols that complement industry standards to reduce length of stay and resource consumption while maintaining quality of care.Distributes hospital issued non coverage notices.Monitors documentation of an appropriate diagnosis for outpatient/observation testing and queries physicians/APPs as needed following AHIMA guidelines.Responds to requests by patient financial services for appeal assistance.Supports Denials Lead RN on Appeals insurance denials for medical necessity for inpatient and outpatient services.Completes documentation worksheet.Queries physician for clarification or missing documentation.Performs chart audits for documentation compliance with CMS standards.Obtains appropriate documentation to comply with core measure standards.Qualifications:Required:Registered Nursing license issued by the State of Illinois.Bachelors of Science Nursing3 or more years of related clinical experiencePreferred:Masters of Science NursingMembership in Professional Nursing OrganizationCertification in Case Management (ACM)Equal OpportunityNorthwestern 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 CheckNorthwestern 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.Artificial Intelligence DisclosureArtificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.BenefitsWe 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.