CLINICAL CASE MANAGER - STROGER HOSPITAL - INPATIENT CARE COORDINATION

PLEASE BE ADVISED that this position is covered by the collective bargaining agreement between Cook County and the National Nurses Organizing Committee. Pursuant to the collective bargaining agreement, Cook County will exhaust internal eligible applicants prior to considering external applicants. Cook County is assembling a list of qualified candidates for this position that will be considered should the position not be filled with internal eligible applicants.

Job Title

Clinical Case Manager

Department

INPATIENT CARE COORDINATION

(Inpatient)

Job Title : Clinical Case Manager

Department: INPATIENT CARE COORDINATION

Location: Stroger Hospital

Shift: 8:00AM - 4:00PM

Job Summary : NNOC MEMBERS ONLY

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.

Typical 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 Processional Nurse in any of the following steps: inpatient care, home care, ED, or patient centered medical home.

Preferred Qualifications

• Bachelors 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.

Physical and Environmental Demands This position is functioning within a healthcare environment. The incumbent is responsible for adherence to all hospital and department specific safety requirements. This includes but i