Description
Be a part of a world-class academic healthcare system at UChicago Medicine as a Case Manager (RN) – Registry at our main medical campus. In this role you will partner with the rest of the clinical team to provide patients the highest quality of care. Our Care Coordination team delivers the highest quality of care while ensuring continuation of care for our patients is a seamless process.
The Case Manager, as part of a multidisciplinary team, including physicians and payers, ensures the patient's progress in the acute episode of care through post discharge and is quality driven while being efficient and cost effective. This role works with the attending and consulting physicians to facilitate effective and efficient transition through the process of hospitalization; works collaboratively with all members of the multi-disciplinary team to ensure patient needs are met and care delivery is coordinated across the continuum, as well as appropriately reimbursed by payers as contracted. The incumbent seeks the expertise of social workers to resolve psychosocial patient care issues and to develop complex patient transition/discharge plan as needed. The incumbent interacts with patients, family members, healthcare professionals, community, and state agencies in this effort. The incumbent serves as a liaison between the hospital and community agencies or facilities for the exchange of clinical and referral information and is responsible for maintaining hospital compliance with the Quality Improvement Organization (QIO) series and CMS guidelines. In addition, the Case Manager-PC provides case review information to third party payers, assists in the denial and appeals process, and assesses quality, levels of care and identifying and reporting potential risk management issues. The incumbent performs duties and tasks in accordance with performance standards established for the job. The incumbent is responsible for participation in and completion of all patient safety initiatives appropriate to the position. The incumbent conducts all job responsibilities according to the Mission and Values of the Hospital.
Essential Job Functions:
- Works in conjunction with physicians, nurses, inter disciplinary team and others to assess, plan and initiate patient plan of care –
- Reviews patient charts daily or as needed.
- Utilizes MSW Social Worker for appropriate referrals: patient/families with complex psychosocial, on-going medical discharge planning issues, continuing care needs and end of life issues.
- Attends care rounds daily, or per unit policy.
- Communicates targets and identified standards of care through collaboration with multidisciplinary team to reduce LOS and inappropriate resource consumption.
- Collaborates with patients, families and other members of the interdisciplinary team as needed.
- Ensures that all critical elements of the care and discharge plan have been communicated to multi-disciplinary team, patient and family including expediting teaching needs.
- Identifies, plans, and facilitates strategies to reduce length of stay and inappropriate resource consumption, working in collaboration with attending and consulting physicians.
- Facilitates and coordinates details of actual discharge to appropriate agencies –
- Initiates discharge plan within 24 hours of admission.
- Initiates a targeted discharge date/time within 24 hours of admission, where appropriate.
- Provides and updates multi-disciplinary team through medical record documentation and pre-defined communication/points of contact regarding potential or planned discharges (e.g., bed meetings).
- Provides and updates referrals to facilities or agencies through online/software discharge planning tools.
- Reviews and completes all appropriate information accompanying patient facility or agency.
- Acts as a liaison between hospital and post-acute facilities or agency to facilitate returns/admissions.
- Facilitates arrangements for time and mode of transportation to facilities for patients.
- Facilitates and coordinates an individualized discharge plan –
- Arranges and participates in care conferences with unit staff, home care staff, patients and/or families.
- Provides adequate avenues of communication through on-going documentation in appropriate systems and telephone/verbal reporting or electronic tools.
- Coordinates and communicates with home care agencies regarding expected standards of care for requested specific treatments.
- Identifies and provides information on requested procedure or medicines.
- Ensures adherence to Quality Standards and Participation in Quality Monitoring and Improvement –
- Participates in departmental and hospital Quality Improvement programs, as directed.
- Documents disposition of patient at discharge.
- Provides adequate documentation of initial assessment and ongoing clinical progress in appropriate system and reviews all referrals for accuracy and content prior to discharge.
- Accepts responsibility for further development of professional learning and growth.
- Actively participates in interdisciplinary projects using the Quality Improvement plan.
- Medical Record Review –
- Conducts inpatient admission reviews for appropriateness of setting, admission status (IP/OP) and level of care (intensive care, general care).
- Conducts on-going case review for continued stay criteria and enters data.
- Monitors quality of care using predetermined criteria.
- Reports potential risk and/or quality management issues identified from medical record review to appropriate departments through defined processes.
- Enters data as requested and appropriate for role, to support Quality Improvement initiatives into appropriate system.
- Third-party Payer Reporting –
- Using approved medical necessity criteria, conducts admission and continued stay review to ensure appropriateness of the setting and timely implementation of the plan of care, to monitor the patient's progress along the continuum of care and intervenes as necessary to ensure appropriateness of setting and that the services provided are quality, efficient and cost effective.
- Consults with Physician Advisor or defined medical staff role (e.g., Attending, Flow Director) as necessary to resolve barriers through appropriate administrative and medical channels to avoid third party payer denials.
- Responds in a timely manner to all requested insurance reviews involving admissions, continued stay, and discharge planning as well as contact for onsite reviewers to confirm hospital will be paid for services provided as contracted.
- Documents in appropriate electronic system by the close of business each day.
- Communicates with admitting and pre-certification regarding level of care status.
- Performs other duties as assigned.
Required Qualifications:
- A Bachelor's degree in Nursing from an NLN accredited school of nursing
- A current Illinois Registered Nurse license
- 3 or more years of Nursing experience
Preferred Qualifications:
- A Master's degree in a related field
- Certification in Case Management
Position Details:
- Job Type/FTE: In-House Registry (0.2 FTE)
- Shift: Days – 8 hour shift – Weekends only
- Unit/Department: Care Coordination
- CBA Code: NNU National Nurses United
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