LOCATION: JOHN H. STROGER HOSPITAL / INTEGRATED CARE - CHICAGO, IL.
The Utilization Management Coordinator, Emergency Department (UMC) serves an important role to support Cook County Health & Hospitals System (CCHHS) goals of efficient, effective, patient-centric care.Using the electronic medical record (EMR) and consulting with the treatment team, the UMC determines if the patient is in the appropriate level of care and if clinical milestones are being met in a timely manner.The UMC provides timely feedback to the treatment team and makes appropriate referrals to other care coordination components for those patients who have barriers to discharge or whose condition requires a different level of care.The successful UMC has a sound clinical foundation, knowledge of utilization management, and critical thinking skills to support effective, timely communication regarding case status.This position requires days, evenings and weekend hours.
This position is exempt from Career Service under the CCHHS Personnel Rules.
- Verifies payer status and medical home (documents same in notes)
- Reviews cases being proposed for inpatient or observation at Stroger and Provident Hospitals within one hour of notification.
- Provides continued stay review at intervals appropriate to the treatment plan and anticipated patient progress.
- Review reflects the ability to:
oTranslate signs, symptoms, lab values, diagnostic testing results, to a MCG guideline. For example the UMC is able to discern the origin of shortness of breath based on history, clinical presentation, vital signs and test results to select the appropriate guideline.
oDocument all relevant information in case notes
oDetects and documents trends and in clinical and functional status data to assess patient progress
- Correctly assigns medical necessity determination and level of care. If different than current assignment, notifies treatment team to alert them and provides recommendations.
- Identifies and refers cases at risk-
oReadmissions within 30 days
oFailure to meet guidelines (either on initial or concurrent review)
oMultiple social determinants impacting care or treatment
oActive MH or SUD
oThose requiring on-going care coordination
oManaged Care Required care coordination
oPlanned re-admission requiring pre-certification
- Uses portals to forward clinical information to payers
- Communicates succinctly and efficiently with stake-holders such as insurance companies, physicians, Inpatient Care Coordination Specialist,
- Escalates case when EMR documentation doesn’t support medical necessity requirement and outreach has not closed gaps.
- Supports and organizes peer to peer conversations to avoid potential denials.
- Participates in departmental quality improvement guidelines
- Completes all educational efforts for CCHHS and licensure
- Completes 25 reviews per day
- Current License as a Registered Professional Nurse in the State of Illinois
- Bachelor’s Degree in Nursing from an accredited college or university(must provide official transcripts at time of interview)
- Five (5) years of acute care, medical surgical, and/ or clinical experience as a registered nurse
- One (1) year of utilization management experience
- Must be able to type 30 word per minute with 80% accuracy(typing test required)
- Successful completion of a Milliman Care Guidelines (MCG) Certification exam within 12 months of employment (Upon hire, the department will maintain responsibility to ensure the employee receives certification within the designated time)
- Bilingual English/Spanish
- In-depth clinical knowledge about common conditions including pathophysiology, standards of care, associated lengths of stay
When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service
To take advantage of this preference a Veteranmust:
Meetthe minimum qualifications for the position.
Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, “Are you a Military Veteran?”
Attach a copy of theirDD 214, DD 215 or NGB 22(Notice of Separation at time of application filing.Please note:If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date.Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11)or the Department of Homeland Security (After 9/11).Discharge papers must list and Honorable Discharge Status.Discharge papers not listing an Honorable Discharge Status are not acceptable.
A copy of avalid State ID Card or Driver’s Licensewhich identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing.
If items are not attached, you will not be eligible for Veteran Preference
VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER’S LICENSE AT TIME OF INTERVIEW.
- Medical, Dental, and Vision Coverage
- Basic Term Life Insurance
- Pension Plan
- Deferred Compensation Program
- Paid Holidays, Vacation, and Sick Time
- You may also qualify forthe Public Service Loan Forgiveness Program (PSLF)
For further information on our excellent benefits package, please click on the following link: http://www.cookcountyrisk.com/
MUST MEET REQUIRED QUALIFICATIONS AT TIME OF APPLICATION
*Degrees awarded outside the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U.S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview.
*Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen.
COOK COUNTY HEALTH AND HOSPITALS SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER