For over 100 years, West Suburban Medical Center has supported generations of families in the Oak Park and surrounding areas. Our kind, caring hospital staff have a passion to heal and make a difference in our community. We understand that our employees are the heart of our facility. If you are looking for a family atmosphere, a company committed to professional growth and a culture that embraces our five core values of Quality. Innovation. Service. Integrity. Transparency.
JOB SUMMARY
This Case Manager is responsible for the development, planning, coordination, and administration of functions including activities such as Utilization Review, Discharge Planning, Social Services and Resource Management, including daily review of medical records to determine appropriateness and medical necessity of admissions, continued hospital stay, and use of ancillary services.
JOB QUALIFICATIONS
Must possess a bachelor's or Associate level degree from an accredited school of nursing.
Current Illinois Registered Nurse License required.
CPR Certification
Ability to establish and maintain effective working relationships with the public.
Must be able to follow directions and to perform work according to department standards when no directions are given.
Must be emotionally mature and able to function effectively under stress.
Must possess crucial thinking skills, effective written and oral communication skills, strong self-initiative, and interpersonal skills.
CCM or CMSA Certified
MS Office Proficient
InterQual or Millman Experience
JOB DUTIES (* denotes "essential function")
Demonstrates the WSMC Customer Service Values, which are key in providing quality service to patients and customers. *
Assists the Medical Staff in conducting an effective Case Management Program.
Retrieves data from medical records to determine if medical necessity or continued stay of patient meets the approved criteria of the Utilization Review function.
Refers cases not meeting the criteria to Physician Advisor and/or the Utilization Review Committee.
Monitors decisions of Physician Advisor and submit report to UR Committee.
Provides necessary assistance to the Utilization Review Committee.
Establishes and maintains a system to identify "Avoidable Days"
Collects, analyzes, and submits data for presentation to Utilization Review Committee.
Submits reports to appropriate review organizations.
Establishes and maintains criteria for identification and resolution of problems associated with the Case Management/Utilization Review Function.
Prepares status reports as required.
Coordinates the overall discharge planning and social services functions, ensuring compliance with federal and state laws and the JCAHO.
Receives client referrals and responds accordingly.
Assists patients, their families, and physicians with post-acute placement.
Maintains a liaison with community agencies offering services to discharged patients.
Maintains rapport with physicians, co-workers, representatives of other organizations and departments.
Ensure patients receive recommended follow-up services throughout the continuum.
Maintains and files appropriate records.
Contacts Child Protective Services or Adult Protective Services with appropriate referrals what fulfill the legal requirements for reporting.
Interprets rules and regulations set by JCAHO, Illinois Department of Health, and other agencies as applicable.
Performs additional assignments and tasks as assigned by management.
Maintains department and corporate LOS and cost per case goals.
West Suburban Medical Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.