What are the responsibilities and job description for the Clinical Case Manager position at Keystone Advisors of Illinois LLC?
Benefits:
- 401(k) matching
- Competitive salary
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Keystone Advisors is looking for a Clinical Case Manager to support one of our healthcare clients in the Illinois Medical District in the West Loop of Chicago.
Job Summary
The Clinical Case Manager uses knowledge of disease processes, health care delivery and financing to support effective, efficient inpatient care while acknowledging patient/family preferences, treatment requirements and self-care capabilities to determine and appropriate discharge plan. These and all other activities are performed in compliance with all Cook County Health & Hospitals System (CCHHS) policies and procedures and in collaboration, as appropriate, with physicians, nurses, therapy department members, social workers, and insurance company representatives.
Job Duties
• Performs an admission review that includes at a minimum the following: an assessment of patient status e.g. inpatient vs. observation; a
determination of whether the patient’s condition meets medical necessity criteria for inpatient care of if significant discharge barriers
exist.
• Validates pay source and physician orders if necessary.
• Collaborates with social work colleague to determine approach to discharge planning and which discipline is most appropriate to lead.
• Calls in review on all cases that require review of whose payer status has not changed. Notifies manager if reviews are incomplete or days
are denied.
• Reassesses patient as clinically indicated or required by payer.
• Documents authorizations and case notes according to departmental policy.
• Presents concise, comprehensive review of assigned patients during rounding.
• Identifies concerns regarding quality and risks. Reports same to supervisor.
• Interacts with physicians regarding medical necessity, identification of appropriate discharge, disposition, reasonable alternatives or
information necessary to support discharge planning.
• Participates in Quality Improvement (QI) activities, pilots, workgroups and other activities to improve departmental operations.
Minimum Qualifications
• Registered Professional Nurse in the State of Illinois
Job Summary
The Clinical Case Manager uses knowledge of disease processes, health care delivery and financing to support effective, efficient inpatient care while acknowledging patient/family preferences, treatment requirements and self-care capabilities to determine and appropriate discharge plan. These and all other activities are performed in compliance with all Cook County Health & Hospitals System (CCHHS) policies and procedures and in collaboration, as appropriate, with physicians, nurses, therapy department members, social workers, and insurance company representatives.
Job Duties
• Performs an admission review that includes at a minimum the following: an assessment of patient status e.g. inpatient vs. observation; a
determination of whether the patient’s condition meets medical necessity criteria for inpatient care of if significant discharge barriers
exist.
• Validates pay source and physician orders if necessary.
• Collaborates with social work colleague to determine approach to discharge planning and which discipline is most appropriate to lead.
• Calls in review on all cases that require review of whose payer status has not changed. Notifies manager if reviews are incomplete or days
are denied.
• Reassesses patient as clinically indicated or required by payer.
• Documents authorizations and case notes according to departmental policy.
• Presents concise, comprehensive review of assigned patients during rounding.
• Identifies concerns regarding quality and risks. Reports same to supervisor.
• Interacts with physicians regarding medical necessity, identification of appropriate discharge, disposition, reasonable alternatives or
information necessary to support discharge planning.
• Participates in Quality Improvement (QI) activities, pilots, workgroups and other activities to improve departmental operations.
Minimum Qualifications
• Registered Professional Nurse in the State of Illinois
• Three (3) years of experience as a Registered Professional Nurse in any of the following steps: inpatient care, home care, ED, or patient
centered medical home
centered medical home
- Experience performing admission reviews that includes assessment of patient status (inpatient vs. observation); a determination of whether the patient’s condition meets medical necessity criteria for inpatient care of if significant discharge barriers exist.
Preferred Qualifications
• Bachelor of Science in Nursing from an accredited institution
• Previous experience with administering medical necessity criteria
• Previous care management experience for patients with multiple chronic disease and acute illness
• Accredited Case Manager (ACM) or Certified Case Manager(CCM)
• Bilingual skills in either English/Spanish or English/Polish
Knowledge, Skills, Abilities and Other Characteristics
• Knowledge of managed care and impact on patient care priorities
• Knowledge of managed care, Medicare and Medicaid
• Knowledge of the admission review process with the ability to conduct patient status assessments
• Excellent interpersonal skills with the ability to work with a culturally diverse patient population and
• collaboratively with physicians, nurses, therapy department members, social workers and insurance company representatives
• Ability to adopt another’s point of view to facilitate patient centered goal setting
• Ability to streamline workflows
• Ability to make sound judgments
• Ability to prioritize, plan, and organize projects and tasks
• Ability to multi-task, manage multiple or competing priorities, and meet deadlines in a fast paced and stressful environment
• Attention to detail
• Basic Office Suite skills to include Outlook, Excel and Word
• Strong initiative
Compensation Package:
• Competitive Salary
• Paid Time Off
• Health, Vision & Dental Insurance
• Health Savings Account (HSA)
• Flexible Spending Account (FSA)
• Short & Long Term Disability
• 401 (K) with company match
• Life Insurance
• Bachelor of Science in Nursing from an accredited institution
• Previous experience with administering medical necessity criteria
• Previous care management experience for patients with multiple chronic disease and acute illness
• Accredited Case Manager (ACM) or Certified Case Manager(CCM)
• Bilingual skills in either English/Spanish or English/Polish
Knowledge, Skills, Abilities and Other Characteristics
• Knowledge of managed care and impact on patient care priorities
• Knowledge of managed care, Medicare and Medicaid
• Knowledge of the admission review process with the ability to conduct patient status assessments
• Excellent interpersonal skills with the ability to work with a culturally diverse patient population and
• collaboratively with physicians, nurses, therapy department members, social workers and insurance company representatives
• Ability to adopt another’s point of view to facilitate patient centered goal setting
• Ability to streamline workflows
• Ability to make sound judgments
• Ability to prioritize, plan, and organize projects and tasks
• Ability to multi-task, manage multiple or competing priorities, and meet deadlines in a fast paced and stressful environment
• Attention to detail
• Basic Office Suite skills to include Outlook, Excel and Word
• Strong initiative
Compensation Package:
• Competitive Salary
• Paid Time Off
• Health, Vision & Dental Insurance
• Health Savings Account (HSA)
• Flexible Spending Account (FSA)
• Short & Long Term Disability
• 401 (K) with company match
• Life Insurance
