Case Manager
ConfidentialChicago, IL, United States12 days ago
Job type
- Permanent
Job descriptionPerform inpatient utilization management per plan, payer requirements, and standards. Collaborate with physicians and healthcare team members for timely and appropriate patient management. Collect and document clinical data to support admission and continued hospitalization. Provide accurate clinical information to payers as required. Support DRG Assurance Program with accurate data collection and assignment. Perform non-acute profiling, collect data on avoidable days, and refer cases to Physician Advisor when needed. Participate in family meetings and care conferences. Ensure timely referrals for discharge planning and use of regional / community resources. Refer complex cases to Social Services as appropriate. Ensure psychological needs of patients are met via direct intervention or referral. Act as a central communicator with patients, families, vendors, payers, and hospital staff. Provide continuity of care by leveraging community resources and maintaining updated resource manuals. Refer cases not meeting criteria to Physician Advisor in a timely manner. Follow up with Medical Director / Physician Advisor on unresolved issues. Maintain safe patient care environment and infection control compliance. Manage departmental operations (phones, supplies, data tracking). Attend in-service presentations and complete all mandatory education. Perform other duties as assigned. Graduate of an accredited school of nursing (Required) Current RN License in Illinois (Required) 2+ years relevant clinical experience (Preferred) Utilization management experience (Preferred) Knowledge of Medicare / Medicaid, Managed Care, and Commercial insurance processes (Preferred) Strong written / oral communication skills with appropriate grammar and vocabulary Proficiency in Microsoft Word and Excel (Required) Ability to provide excellent customer service at all times Ability to anticipate and coordinate multiple functions effectively
Position
Title : Utilization Review / Case Manager (RN)
Reports To : Clinical Director, Behavioral Health Services
Term : Permanent, Full-time
Benefits
- 401(K) matching – 4%
- Dental Insurance
- Health Insurance
- Life Insurance
- Paid time off
- Vision Insurance
- Paid Sick Time – effective after 90 days
- Paid Vacation Time – effective after 90 days
- Health, Vision & Dental Benefits – eligible at 30 days (following the 1st of the next month)
- Short & Long-Term Disability + Basic Life Insurance – after 30 days of employment
General Summary
The Utilization Review / Case Manager facilitates appropriate use of hospital resources by ensuring that patients meet acute inpatient criteria and anticipates discharge needs in a timely manner. The role acts as a central communicator with external and internal customers, collaborating with social workers, case managers, vendors, payers, and community agencies.
Key Responsibilities
Utilization Management
Discharge Planning
Communication & Coordination
Other Duties
Knowledge, Skills & Abilities
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Case Manager • Chicago, IL, United States
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