Utilization Mgmt. RN Care Coordination Full Time Evenings

Job Description

This position is in the ED: 6:00pm -2:00AM. Monday through Friday. No weekends /holidays. This is not a remote position.

Responsibilities

• Concurrent review of patients clinical information for efficiency and correct level of care and admission status
• Interface with payers concurrently and after discharge to obtain authorization
• Concurrent denials management
• Collaborates with the denials management team
• Ongoing review of pre-certification requests for medical necessity
• Maintain oversight of clinical and non-clinical staff activities
• Collaborate with the health care team and payers to assist with coordinating patients discharge planning needs
• Employ effective use of knowledge, critical thinking and skills
• Work in an intensive, fast-paced environment with minimal supervision
• Ability to stay organized and interact well with others in any situation
• Provide updates to Director of Utilization Management for review

Qualifications

• Required:
• Bachelor's degree in Nursing
• State licensure as a Registered Nurse (RN)
• Preferred:
• Master's degree
• Minimum 2 years of prior experience in Utilization Management
• Utilization Management or Case Management certification

Additional Information

Northwestern Medicine is an equal opportunity employer (disability, VETS) 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.

Background Check

Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check. Results are evaluated on a case-by-case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.

Artificial Intelligence Disclosure

Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.

Benefits

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.