Ann & Robert H. Lurie Children’s Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Ann & Robert H. Lurie Children’s Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report.

Day (United States of America)

Location

Ann & Robert H. Lurie Children's Hospital of Chicago

Job Description

K.S.A.'s:

1.    LCSW, LCPC or similar licensure required. 
2.    Experience with EPIC preferred.
3.    Two to four years relevant clinical experience, current knowledge of health care trends and practices related to pediatric healthcare and case management. 
4.    Working knowledge of hospital revenue cycle and payer reimbursement methodologies
5.    Experience working in partnership with healthcare professionals and support staff.
6.    Strong problem solving skills.
7.    Demonstrates flexibility and ability to adjust in a changing environment.
8.    Proficiency with Excel, PowerPoint, and other database tools/applications.
9.    Excellent written and verbal communication skills.
 

Job Duties:

1.    Care Coordination, Collaboration and Facilitation.
        The emphasis is on care coordination and positive partnerships with multiple disciplines (clinical 
    and non-clinical) in order to pace the care toward optimal outcomes within the appropriate level of 
    care.
Accountability/Responsibility:
•    Collaborates with the interdisciplinary team; participating in team rounds to: 
o    Facilitate timely care 
o    Assure quality of care throughout the hospital stay, minimizing adverse outcomes. 
•    Communicates with Admitting or PFS regarding the needs of the patient, payer and provider. 
•    Communicates relevant elements of the patient’s health plan benefits.
•    Understands the target LOS on every patient at the time of the initial review and identifies the anticipated date of discharge for planning and care coordination purposes. 
•    Maintains an open line of communication with other disciplines regarding the target LOS and anticipated discharge date. 
•    Documents all team, physician and patient/family communication and concerns pertaining to coordination of care and services. 
•    Participates in unit bed huddles and/or multi-disciplinary rounds.
2.    Utilization Management
Consistently applies the utilization management process as required by the Code of Federal Regulations, including the use InterQual Evidenced Based Medical Necessity criteria for primary review. Incorporates into the utilization management process the ability to access and interpret clinical information against InterQual Evidenced Based Medical Necessity criteria to reach correct admission status determinations. Has the current knowledge of applicable regulations and laws pertaining to the major payers including Medicare, Medicaid, and other payers. Works with the interdisciplinary team to ensure that the care and services provided are medically necessary, delivered efficiently and timely, and at the appropriate level of care to meet payer requirements and established financial and performance benchmarks.
Accountability/Responsibility: 
•    Completes medical necessity utilization reviews and shares the outcome with multidisciplinary team within required timeframes. 
•    Notifies Admitting Department of errors or needed changes in patient data including changes in physician orders/incorrect admission status designation. 
•    Coordinates internal and external services to avoid under or over utilization of resources. 
•    Facilitates or participates in interdisciplinary team meetings or rounds. 
•    Reviews record including physician orders and documents admission, concurrent, discharge reviews and retrospective reviews as assigned. 
•    Communicates with physicians regarding the level of care or admission status when appropriate criteria are not met for inpatient, or Partial Hospitalization Program. 
•    Identifies avoidable delays in care or delays in discharge, attempts to resolve delays and document identified avoidable or denied days on a daily basis. 
•    Provides and documents concurrent reviews or other information requested by the payer within required timeframes.
3.  Professionalism, Quality, Growth and Safety
Employees will conduct their job functions in a manner consistent with their professional licensure and will demonstrate willingness to learn, improve, grow and achieve. 
Accountability/Responsibility: 
•    Demonstrates responsibility for professional development and growth including identifying continuing education needs and seeking learning opportunities that will enhance job performance and professional satisfaction. 
•    Effectively organizes work priorities. 
•    Demonstrates compliance with facility and departmental safety and security policies and practices. 
•    Educates hospital team members and physicians about the Case Manager Role and scope of practice. 
•    Supports the hospital quality, risk and performance improvement programs. 
4.  Other job functions as assigned.
 

Education

Pay Range

$65,520.00-$107,120.00 Salary

At Lurie Children’s, we are committed to competitive and fair compensation aligned with market rates and internal equity, reflecting individual contributions, experience, and expertise. The pay range for this job indicates minimum and maximum targets for the position. Ranges are regularly reviewed to stay aligned with market conditions. In addition to base salary, Lurie Children’s offer a comprehensive rewards package that may include differentials for some hourly employees, leadership incentives for select roles, health and retirement benefits, and wellbeing programs. For more details on other compensation, consult your recruiter or click the following link to learn more about our benefits.

Benefit Statement

For full time and part time employees who work 20 or more hours per week we offer a generous benefits package that includes:

Medical, dental and vision insurance

Employer paid group term life and disability

Employer contribution toward Health Savings Account

Flexible Spending Accounts

Paid Time Off (PTO), Paid Holidays and Paid Parental Leave

403(b) with a 5% employer match

Various voluntary benefits:

Supplemental Life, AD&D and Disability

Critical Illness, Accident and Hospital Indemnity coverage

Tuition assistance

Student loan servicing and support

Adoption benefits

Backup Childcare and Eldercare

Employee Assistance Program, and other specialized behavioral health services and resources for employees and family members

Discount on services at Lurie Children’s facilities

Discount purchasing program

There’s a Place for You with Us

At Lurie Children’s, we embrace and celebrate building a team with a variety of backgrounds, skills, and viewpoints — recognizing that different life experiences strengthen our workplace and the care we provide to the Chicago community and beyond. We treat everyone fairly, appreciate differences, and make meaningful connections that foster belonging. This is a place where you can be your best, so we can give our best to the patients and families who trust us with their care.  

 

Lurie Children’s and its affiliates are equal employment opportunity employers.  All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity or expression, religion, national origin, ancestry, age, disability, marital status, pregnancy, protected veteran status, order of protection status, protected genetic information, or any other characteristic protected by law.

Support email: candidatesupport@luriechildrens.org