Insight Hospital and Medical Center
ED UTILIZATION REVIEW/CASE MANAGER
Insight Hospital and Medical Center - Chicago, Illinois, United States, 60290
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ED UTILIZATION REVIEW/CASE MANAGER
role at
Insight Hospital and Medical Center . WE ARE INSIGHT
Read on to fully understand what this job requires in terms of skills and experience If you are a good match, make an application.
At Insight Hospital and Medical Center Chicago, we believe in providing quality healthcare and achieving health equity. Our Chicago location aims to build a community hospital in the Bronzeville area, increasing services to meet community needs. We are dedicated to delivering compassionate, expert, and impactful care, ensuring patient care is second to none. Join our team to be part of our future success! General Summary The ED Utilization Review/Case Manager ensures appropriate use of hospital resources by verifying inpatient criteria and assisting with discharge planning. This role involves communication with external and internal stakeholders, including vendors, payers, community agencies, patients, families, and hospital staff. The individual collaborates with social workers and case managers and manages departmental office functions such as answering phones, ordering supplies, data entry, and tracking. Duties and Responsibilities
Manage inpatient utilization activities per hospital standards and payer requirements. Collaborate with healthcare team members for patient management. Collect data to support admission necessity and ongoing hospitalization. Support DRG assurance through accurate data collection and documentation. Provide clinical information to payers as needed. Resolve system issues affecting diagnosis or treatment delays. Perform profiling on avoidable days and physician referral codes. Facilitate safe patient discharges, participate in family meetings, and ensure timely referrals for discharge planning. Refer complex cases to Social Services and utilize community resources. Meet patients' psychological needs through intervention or consultation. Maintain communication with physicians regarding care and reimbursement issues. Determine and communicate benefits and level of care changes. Coordinate with Medical Director/Physician Advisor for case resolutions. Develop and practice customer service skills, maintaining updated resource manuals. Seek cost control measures that do not compromise safety or quality. Participate in staff training and mandatory education. Additional Duties
Maintain a safe environment and operate equipment properly. Follow infection control protocols. Stay informed about hospital updates and attend staff meetings. Perform other duties as assigned. Qualifications
Graduate of an accredited nursing program. Current RN license in Illinois. Two years of clinical experience preferred. Utilization management experience preferred. Knowledge of insurance review processes preferred. Strong communication and organizational skills. Proficient in Microsoft Word and Excel. Excellent customer service skills. Benefits
Paid sick and vacation time after 90 days. Health, vision, and dental insurance after 30 days. Disability and life insurance after 30 days. Insight is an equal opportunity employer valuing diversity. Job Details
Seniority level: Entry level Employment type: Full-time Job function: Other Industry: Hospitals and Health Care Referrals can double your chances of interview success. Apply now to join our team!
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ED UTILIZATION REVIEW/CASE MANAGER
role at
Insight Hospital and Medical Center . WE ARE INSIGHT
Read on to fully understand what this job requires in terms of skills and experience If you are a good match, make an application.
At Insight Hospital and Medical Center Chicago, we believe in providing quality healthcare and achieving health equity. Our Chicago location aims to build a community hospital in the Bronzeville area, increasing services to meet community needs. We are dedicated to delivering compassionate, expert, and impactful care, ensuring patient care is second to none. Join our team to be part of our future success! General Summary The ED Utilization Review/Case Manager ensures appropriate use of hospital resources by verifying inpatient criteria and assisting with discharge planning. This role involves communication with external and internal stakeholders, including vendors, payers, community agencies, patients, families, and hospital staff. The individual collaborates with social workers and case managers and manages departmental office functions such as answering phones, ordering supplies, data entry, and tracking. Duties and Responsibilities
Manage inpatient utilization activities per hospital standards and payer requirements. Collaborate with healthcare team members for patient management. Collect data to support admission necessity and ongoing hospitalization. Support DRG assurance through accurate data collection and documentation. Provide clinical information to payers as needed. Resolve system issues affecting diagnosis or treatment delays. Perform profiling on avoidable days and physician referral codes. Facilitate safe patient discharges, participate in family meetings, and ensure timely referrals for discharge planning. Refer complex cases to Social Services and utilize community resources. Meet patients' psychological needs through intervention or consultation. Maintain communication with physicians regarding care and reimbursement issues. Determine and communicate benefits and level of care changes. Coordinate with Medical Director/Physician Advisor for case resolutions. Develop and practice customer service skills, maintaining updated resource manuals. Seek cost control measures that do not compromise safety or quality. Participate in staff training and mandatory education. Additional Duties
Maintain a safe environment and operate equipment properly. Follow infection control protocols. Stay informed about hospital updates and attend staff meetings. Perform other duties as assigned. Qualifications
Graduate of an accredited nursing program. Current RN license in Illinois. Two years of clinical experience preferred. Utilization management experience preferred. Knowledge of insurance review processes preferred. Strong communication and organizational skills. Proficient in Microsoft Word and Excel. Excellent customer service skills. Benefits
Paid sick and vacation time after 90 days. Health, vision, and dental insurance after 30 days. Disability and life insurance after 30 days. Insight is an equal opportunity employer valuing diversity. Job Details
Seniority level: Entry level Employment type: Full-time Job function: Other Industry: Hospitals and Health Care Referrals can double your chances of interview success. Apply now to join our team!
#J-18808-Ljbffr