Case Manager - Utilization Review RN
Key Skills for This Role
Full Job Posting
Community First Medical Center offers benefits to all its full-time and part-time employees
- United Healthcare Medical PPO/HMO/HSA Plans, premiums as low as $50.00/full time, $85.00/Part Time
- Met Life Dental and Vision
- Paid Time Off (PTO) with annual accruals up to 168 hrs./year
- Six paid holidays
- Company Paid Life insurance and Short-term Disability
- 401(k) after 90 days
- Continuing Education reimbursement and 2 days paid off separate from PTO
- Free Parking Garage
- Internal Growth Opportunities
- Requirements
- To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education
Associate Degree in Nursing required.
Bachelor of Science in Nursing (BSN) preferred.
Experience
Minimum three (3) years of acute care nursing experience required.
Minimum two (2) years of Case Management and/or Utilization Review experience preferred.
Experience with discharge planning, utilization review, denial management, and payer authorization preferred.
Licensure
Current Illinois Registered Nurse license required.
ACM, CCM, or CMAC certification preferred.
KNOWLEDGE, SKILLS & ABILITIES
- Knowledge of Medicare, Medicaid, and commercial insurance regulations.
- Working knowledge of InterQual and/or MCG criteria.
- Behavioral Health background knowledge
- Access to Behavioral Health Networks
- Understanding of utilization management and care coordination principles.
- Knowledge of discharge planning and post-acute care resources.
- Strong analytical and critical thinking skills.
- Excellent verbal and written communication skills.
- Ability to prioritize multiple complex patient cases.
- Ability to build collaborative relationships with physicians and interdisciplinary teams.
- Computer proficiency and electronic medical record experience.
PERFORMANCE EXPECTATIONS
Success in this role is measured by:
Appropriate admission status determination
Denial prevention and appeal success
Timely discharge planning
Reduction in avoidable days
Average Length of Stay management
Readmission reduction
Documentation compliance
Regulatory compliance
Patient throughput
Patient and physician satisfaction
Salary Description
43.47-$53.00
Requirements
- Knowledge of Medicare, Medicaid, and commercial insurance regulations.
- Working knowledge of InterQual and/or MCG criteria.
- Behavioral Health background knowledge
- Access to Behavioral Health Networks
- Understanding of utilization management and care coordination principles.
- Knowledge of discharge planning and post-acute care resources.
- Strong analytical and critical thinking skills.
- Excellent verbal and written communication skills.
- Ability to prioritize multiple complex patient cases.
- Ability to build collaborative relationships with physicians and interdisciplinary teams.
- Computer proficiency and electronic medical record experience.
About Community First Medical Center
Private benefit-corporation hospital providing medical, emergency, diagnostic, rehabilitation, and nursing care to Chicago’s Portage Park community.
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