Case Manager Care Coordination Full time Days

Full time, Monday–Friday 8:00 AM–4:30 PM, plus one weekend every 5 weeks and 1–2 holidays per year.

About the role

As an integral part of the Northwestern Medicine team, you will help coordinate each patient’s stay from admission through discharge, ensuring medically appropriate, cost-effective care and safe, timely movement along the continuum of care.

Responsibilities

• In collaboration with the patient/family and the health care team, assess, plan, implement, and evaluate the plan of care and the patient’s response to treatment.
• Proactively collaborate with and educate physicians and the multidisciplinary team on appropriateness of admission, continued stay, resource utilization, and expected length of stay.
• Refer appropriate cases to patient financial services, peer review, patient relations, and risk management.
• Clarify admission status and plan of care with physicians and other team members.
• Utilize all available tools and resources to gain a complete clinical assessment of the patient; notify physicians and staff of concerns or variations.
• Relay pertinent information to the care team regarding admission, continuum of care, and discharge concerns.
• Ensure the interdisciplinary care plan and discharge plan are comprehensive, consistent with the patient’s clinical course, and coordinated with covered services.
• Assess and reassess the patient for ongoing care needs, initiate timely referrals to appropriate resources, and progress toward the discharge plan.
• Participate in rounds and complex patient care conferences, identifying needs, barriers, and action plans.
• Perform utilization management activities for all inpatients and observation patients using approved criteria; notify the physician advisor of any outlier cases.
• Provide timely and thorough reviews to third-party payers as requested or required, minimizing denials based on lack of medical necessity.
• Maintain a working knowledge of available extended-care providers; research unfamiliar cases and patient insurance plans to offer in-network options.
• Partner with nursing staff and physicians to convey accurate, timely information to post-acute care providers for a smooth, safe discharge.
• Proactively identify and coordinate patient and family educational needs with the care delivery team.
• Ensure the patient is at the most appropriate level of care for their severity of illness and required services, applying national guidelines and clear communication with physicians.
• Coordinate appropriate bed placement, collaborating on location and staffing.
• Query the admitting physician for additional information to meet medical necessity for admission or appropriate level of care; refer outlier cases to the physician advisor.
• Coordinate patient activity and flow between levels of care; identify potential throughput barriers and alert management of anticipated delays.
• Review clinical data against Milliman criteria to determine patient class and level of care; confer with physicians as needed.

Requirements

• Bachelor of Science in Nursing (required for hires after 01/01/2011).
• Registered Nurse licensure in the state of Illinois.
• One year of case management experience in an acute hospital setting.

Preferred Qualifications

• Two years’ experience in utilization review.
• Case management certification.
• Prior experience in case management or an insurance setting.
• Bilingual proficiency.

Benefits

• Competitive health, dental, and vision coverage.
• 401(k) matching.
• Tuition reimbursement and loan forgiveness.
• Lifecycle benefits (e.g., wellness programs, mental-health resources).

Schedule

Full time, Monday–Friday 8:00 AM–4:30 PM, plus one weekend every 5 weeks and 1–2 holidays per year.