UTILIZATION MANAGEMENT COORDINATOR - INPATIENT CARE COORDINATION

Cook County Government

Chicago, IL 60684

Posted 1 month ago

Job Description

**_JOB SUMMARY_****: ** **LOCATION: JOHN H. STROGER HOSPITAL / INTEGRATED CARE - CHICAGO, IL.** **SHIFT: ****SHIFT: ****8:00 AM - 4:00 PM M-F & WEEKENDS 11:00 AM - 7:00 PM (ROTATING EVERY 6 WEEKS) ** ** __** 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. **_Typical Duties_** * 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: * Translate 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. * Document all relevant information in case notes * Detects 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- * Readmissions within 30 days * Failure to meet guidelines (either on initial or concurrent review) * Multiple social determinants impacting care or treatment * Active MH or SUD * Those requiring on-going care coordination * Managed Care Required care coordination * Planned 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 ***Minimum Qualifications*** * 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) **_Preferred Qualifications_** * Bilingual English/Spanish * In-depth clinical knowledge about common conditions including pathophysiology, standards of care, associated lengths of stay **_VETERAN PREFERENCE_** **_PLEASE READ_** 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 Veteran **_must_:** * Meet the 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 their **DD 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._** **OR** A copy of a **valid State ID Card or Driver’s License** which 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.** **_Benefits Package_** * **Medical, Dental, and Vision Coverage** * **Basic Term Life Insurance** * **Pension Plan** * **Deferred Compensation Program** * **Paid Holidays, Vacation, and Sick Time** * **You may also qualify for the 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. ** ***CCHHS is strictly prohibited from conditioning, basing or knowingly prejudicing or affecting any term or aspect of County employment or hiring upon or because of any political reason or factor.** **COOK COUNTY HEALTH AND HOSPITALS SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER** *Job Posting:* Dec 17, 2018, 2:22:42 PM *Closing Date:* Ongoing *Organization:* Health and Hospital Systems *Req ID:* 00122339



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