Nurse Case Manager Full time Days

The salary range for this position is $40.50 - $64.80 (Hourly Rate). Placement within the salary range is dependent on several factors such as relevant work experience and internal equity. For positions represented by a labor union, placement within the salary range is guided by the rules outlined in the collective bargaining agreement. We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well‑being while protecting against unexpected life events. Please visit our Benefits section located at jobs.nm.org/benefits to learn more. Northwestern Medicine is powered by a community of colleagues who are purpose‑driven and committed to our mission to deliver world‑class care. Here, you'll work alongside some of the best clinical talent in the nation leading the way in medical innovation and breakthrough research with Northwestern University Feinberg School of Medicine. We recognize where you've been, and we support where you're headed. We celebrate diverse perspectives and experiences, which fuel our commitment to equity and a culture of service. Grow your career with comprehensive training and development opportunities, mentorship programs, educational support and student loan repayment. Create the life you envision for yourself with flexible work options, a Reimbursable Well‑Being Fund and a Total Rewards package that supports your physical, mental, emotional, and financial well‑being. Make a difference through volunteer opportunities we offer in local communities and drive inclusive change through our workforce‑led resource groups. Benefits

• 10,000 Tuition Reimbursement per year ($5,700 part‑time)
• 10,000 Student Loan Repayment ($5,000 part‑time)
• 1,000 Professional Development per year ($500 part‑time)
• 250 Well‑Being Fund per year ($125 for part‑time)

Matching 401(k) Excellent medical, dental and vision coverage Life insurance Annual Employee Salary Increase and Incentive Bonus Paid time off and Holiday pay Description Position Summary The Nurse Case Manager 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 other regulatory and accreditation standards. Assists in coordinating the patient’s stay from admission through discharge, expediting medically appropriate, cost‑effective care and ensuring the patient moves along the continuum of care safely and timely. Days, one weekend a month is required. This will be heavily involved with Utilization Management. Responsibilities In collaboration with the patient/family and members of the health care team, assess, plan, implement, and evaluate the plan of care and the patient’s response to treatment. Proactively collaborate and educate physicians and multidisciplinary team on the appropriateness of admission, continued stay, utilization of resources and expected LOS. Refer appropriate cases to patient financial services, peer review, patient relations, risk management. Collaborate with physicians and other health care team members to clarify admission status and plan of care. Utilize all available tools and resources to gain a complete picture of clinical assessment of the patient; notify physicians and staff of concerns or variations. Relay pertinent information to appropriate care team members regarding admission, continuum of care and discharge concerns. Ensure that the interdisciplinary care plan and the discharge plan are comprehensive and consistent with the patient’s clinical course and coordinated with covered services as available. Assess and reassess the patient for ongoing care needs with knowledge of high‑risk criteria and initiate referrals to appropriate resources in a timely manner to progress toward the discharge plan. Participate in rounds and complex patient care conferences as indicated, identifying needs, barriers, and action plans. Perform utilization management activities of all inpatients and observation patients by applying approved criteria; notify physician advisor of any outlier cases. Provide timely and thorough reviews to third‑party payers as requested or required, aiming for minimal denials based on lack of medical necessity. Maintain a good working knowledge of available and diverse extended care providers for the general population served; seek references from co‑workers for unfamiliar cases. Research patient insurance plans to offer in‑network providers of care and allow the patient to make informed decisions. Partner with the nursing staff and physicians to convey accurate and timely information to post‑acute care providers to encourage smooth hand‑off and create a seamless and safe discharge to the next continuum of care. Partner with the care delivery team to identify proactively and coordinate any educational needs for the patient and family. Ensure the patient is at the most appropriate level of care for the expressed severity of illness and level of services required; apply National Guidelines and clear communication with physicians. Coordinate appropriate bed placement for patients with Patient Care Services, collaborating on location, staffing, etc. Query the admitting physician for additional information as needed to meet medical necessity for admission or appropriate level of care and refer cases to physician advisor for outlier cases. Coordinate patient activity and flow or movement between levels of care; identify potential throughput barriers and proactively inform upper management of anticipated delays. Review clinical data against Milliman criteria to help determine patient class and level of care needed; confer with MD to discuss clinical and appropriate level of care when needed. Competencies / Performance Expectations Communicate in a non‑threatening way that conveys caring and respect for patients, families, and co‑workers. Exhibit effective communication and interpersonal skills with those who express diverse cultural backgrounds, various ages, and otherwise challenged; utilize translators, social workers, or patient relations when indicated. Qualifications Required Bachelor of Science in Nursing (required for hires after 01/01/2011) Registered Nurse in the state of Illinois One year of case management experience in an acute hospital setting Preferred Two years’ experience in utilization review Case management certification Prior experience in case management or insurance setting Bilingual Equal Opportunity 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. Management Responsibility This position will not have any direct reports. Population Served N/A 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. Artificial Intelligence Disclosure Artificial 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. 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 on the job family. #J-18808-Ljbffr Northwestern Medicine Delnor Hospital