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Case Manager

Case Manager

ConfidentialChicago, IL, United States
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Position

Title : Utilization Review / Case Manager (RN)

Reports To : Clinical Director, Behavioral Health Services

Term : Permanent, Full-time

Benefits

  • 401(K) matching – 4%
  • Dental Insurance
  • Health Insurance
  • Life Insurance
  • Paid time off
  • Vision Insurance
  • Paid Sick Time – effective after 90 days
  • Paid Vacation Time – effective after 90 days
  • Health, Vision & Dental Benefits – eligible at 30 days (following the 1st of the next month)
  • Short & Long-Term Disability + Basic Life Insurance – after 30 days of employment

General Summary

The Utilization Review / Case Manager facilitates appropriate use of hospital resources by ensuring that patients meet acute inpatient criteria and anticipates discharge needs in a timely manner. The role acts as a central communicator with external and internal customers, collaborating with social workers, case managers, vendors, payers, and community agencies.

Key Responsibilities

Utilization Management

  • Perform inpatient utilization management per plan, payer requirements, and standards.
  • Collaborate with physicians and healthcare team members for timely and appropriate patient management.
  • Collect and document clinical data to support admission and continued hospitalization.
  • Provide accurate clinical information to payers as required.
  • Support DRG Assurance Program with accurate data collection and assignment.
  • Perform non-acute profiling, collect data on avoidable days, and refer cases to Physician Advisor when needed.
  • Discharge Planning

  • Participate in family meetings and care conferences.
  • Ensure timely referrals for discharge planning and use of regional / community resources.
  • Refer complex cases to Social Services as appropriate.
  • Ensure psychological needs of patients are met via direct intervention or referral.
  • Communication & Coordination

  • Act as a central communicator with patients, families, vendors, payers, and hospital staff.
  • Provide continuity of care by leveraging community resources and maintaining updated resource manuals.
  • Refer cases not meeting criteria to Physician Advisor in a timely manner.
  • Follow up with Medical Director / Physician Advisor on unresolved issues.
  • Other Duties

  • Maintain safe patient care environment and infection control compliance.
  • Manage departmental operations (phones, supplies, data tracking).
  • Attend in-service presentations and complete all mandatory education.
  • Perform other duties as assigned.
  • Knowledge, Skills & Abilities

  • Graduate of an accredited school of nursing (Required)
  • Current RN License in Illinois (Required)
  • 2+ years relevant clinical experience (Preferred)
  • Utilization management experience (Preferred)
  • Knowledge of Medicare / Medicaid, Managed Care, and Commercial insurance processes (Preferred)
  • Strong written / oral communication skills with appropriate grammar and vocabulary
  • Proficiency in Microsoft Word and Excel (Required)
  • Ability to provide excellent customer service at all times
  • Ability to anticipate and coordinate multiple functions effectively
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    Case Manager • Chicago, IL, United States

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