Northwestern Memorial Healthcare is looking for a Case Manager RN to join the team at Lake Forest Hospital. This is a full-time salaried position working 40 hours per week on day shifts. The successful candidate will embody our mission, vision, and values while adhering to organizational policies and regulatory standards.
What You'll Do
- Develop individualized treatment plans for patients in collaboration with the patient and their family.
- Coordinate and lead care conferences on patients with length of stays greater than 7 days.
- Document unusual occurrences and patient relations issues, making appropriate referrals to risk management, infection control, and quality departments.
- Assess patient and family needs for appropriate discharge services.
- Coordinate transfer to appropriate level of care such as skilled care, rehabilitation, custodial, and home health care.
- Document discharge planning on the interdisciplinary plan of care, in progress notes, and education record.
- Maintain current knowledge of community resources to support a continuum of effective services.
- Deliver notice of Medicare discharge appeal rights within the appropriate time frame.
- Assist physicians in assigning admission status.
- Perform medical record review to assess for appropriateness of admissions and continued hospital stay.
- Monitor avoidable days and recommend change in services or processes.
- Educate staff on CPGs, Standing Orders, and Protocols to reduce length of stay and resource consumption while maintaining quality of care.
- Ensure compliance with managed care contracts and length of stay targets.
- Distribute hospital-issued non-coverage notices.
- Monitor documentation of an appropriate diagnosis for outpatient/observation testing and query physicians/APPs as needed following AHIMA guidelines.
- Respond to requests by patient financial services for appeal assistance.
- Support the Denials Lead RN on appeals for insurance denials for medical necessity for inpatient and outpatient services.
- Complete documentation worksheets.
- Query physicians for clarification or missing documentation.
- Perform chart audits for documentation compliance with CMS standards.
- Obtain appropriate documentation to comply with core measure standards.
What We're Looking For
- Registered Nursing license issued by the State of Illinois.
- Bachelor's of Science in Nursing (BSN).
- 3 or more years of related clinical experience.
Nice to Have
- Master's of Science in Nursing (MSN).
- Membership in a Professional Nursing Organization.
- Certification in Case Management (ACM).
Benefits & Compensation
- Compensation Range: $40.50-$64.80 per hour.
- Tuition reimbursement.
- Loan forgiveness.
- 401(k) matching.
- Lifecycle benefits.
Work Mode
This is an onsite position located at 900 N. Westmoreland, Lake Forest, IL.
Northwestern Medicine is an affirmative action/equal opportunity employer 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.
