About the job
Join our team at Northwestern Medicine as a Casual Registered Nurse Case Manager in Utilization Review, working remotely on weekends. This position is essential for supporting our Case Management UR department at Northwestern Medicine Catherine Gratz Griffin Lake Forest Hospital.
The Case Manager RN UR/Bed Planner embodies the values and mission of Northwestern Medicine, adhering to our Code of Ethics and Corporate Compliance Program. This role requires compliance with all relevant policies, procedures, guidelines, and regulatory standards.
Key Responsibilities:
- Evaluate patient care needs and determine appropriate admission status while utilizing established criteria and managed care guidelines to facilitate seamless patient admissions.
- Work collaboratively with attending physicians to ensure correct hospital status orders.
- Conduct chart reviews to ascertain suitable levels of care and admission statuses.
- Assign patients to appropriate units based on clinical assessments while optimizing organizational resources.
- Coordinate with unit charge nurses for effective bed placements.
- Assist in resolving throughput issues by collaborating with nursing operations leaders.
- Act as a primary resource for physicians, staff, and patients regarding access points.
- Manage bed requests and transfer orders within the electronic medical record.
- Document and address any unusual occurrences or patient relations issues, referring to risk management and quality departments as necessary.
- Analyze quality and utilization cases, including admission/discharge criteria and readmission metrics.
- Stay informed about Medicare regulations concerning hospital admissions.
- Review medical records to ensure appropriate admissions and collaborate with emergency room and attending physicians to prevent unnecessary admissions.
- Monitor avoidable days and suggest improvements in services or processes.
- Provide support to denials management RN for appeals.
- Assist in data collection and reporting for throughput and bed placement.
- Conduct chart audits at the request of management.
AA/EOE.