Lead Emergency Department URBed Planner Case Management Full-time Nights 4000 sign-on bonus

• This role is 36/hours per week on the 3rd shift.

The Lead ED Quality Utilization Specialist reflects the mission vision and values of NM adheres to the organizations Code of Ethics and Corporate Compliance Program and complies with all relevant policies procedures guidelines and all other regulatory and accreditation standards.

The Lead ED Quality Utilization Specialist has achieved a mastery of utilization review principles and facilitates improvement in the overall completeness and accuracy of medical necessity level of care and hospital status assignment.  The Lead ED Quality Utilization Specialist applies clinical and utilization review expertise knowledge of the national quality agenda professional nursing standards best practices and interdisciplinary collaboration to assist in the accuracy assessment of utilization review functions that have been performed.  The Lead partners with Hospital Throughput Inpatient Nursing the Emergency Department treatment team and the clinical care team to help promote the most accurate level of care or hospital status and ensure the patient is assigned the most appropriate type of unit given the bestknown hospital status at the time. These determinations are made with the information/labs/results and assessments at that given time and is a dynamic process.  

The Lead ED Quality Utilization Specialist acts as a change agent to systematically drive and implement change as prioritized by Quality Utilization leadership the Quality Utilization Committee and senior hospital and clinical leadership.  The Lead participates in performance improvement initiatives receives and monitors control plans and data trends under review of the Quality Utilization Team and in collaboration with clinician practices. The key to this role is the ability to lead and facilitate with key stakeholders as well as oversee and coach the QU ED team members through complex projects and difficult conversations.

Responsibilities:

• Partners with current senior leadership to act as a change agent to methodically prioritize and execute workflow as designated by Quality Utilization Leadership the Quality Utilization Committee and senior hospital/clinical leadership to navigate decisions at risk for conflict and evaluate immediate destination of patients to determine whether urgent interventions were ineffective.
• Partners with ED physicians APPs admitting team and the Patient Throughput Coordinators (PTCs)  to assign an initial level of care and influence patient bed placement location when appropriate.
• Acts as a change agent to lead timely assessment and conversion of ED patient status to Observation with key stakeholders.
• Intervenes to reevaluate immediate destination of patient and/or for patients that fail to meet immediate disposition criteria.
• Navigates challenging conversations with MDs APPs Leads and administrative team members in an effort to determine the most accurate initial status and subsequent bed placement and escalates trends as appropriate. Proactively navigates patient care scenarios that are atrisk for conflict.
• Responsible for initiatives leading to crossdepartmental change and program enhancements; the Lead QUS ED anticipates issues interprets internal/ external issues and helps lead problem resolution.
• Leads QUS ED team in identifying priority observation reviews after bed change.
• Provides formal and informal ongoing education to ED Residents APPs and Medical Staff
• Charters process improvement initiatives and committees to address areas of conflict and to address areas of opportunity for improvement and/or RCA of case outcome.
• Escalates cases as appropriate to the Quality Utilization Medical Directors or leadership for second level review as appropriate.
• Assists novice Quality Utilization Specialist ED in execution of status determinations.
• Acts as a mentor for the entire QU department and fosters an environment of collaboration across the team.
• Performs medical record reviews and other data collection activities that assist in identifying possible documentation issues and/or status inaccuracies for improvement.
• Assists Quality Utilization Nurse Auditor to develop standards participate in ongoing ED audit process monitor ED competencies provide feedback and to reevaluate clinical audit tools as needed.
• Applies knowledge of professional practice QU standards Best Practices and interdisciplinary collaboration for problem analysis resolution and creative process redesign. Leverages NMH network to initiate conversations identify root causes and resolution and align resources.
• Responsible to lead QU efforts in support of NMH strategical initiatives under direction of QU and Patient Care Leadership.
• Analyzes case review data to accurately identify trends that require improvement.
• Instructs QU team/ ED team and distributes updated information on Level of Care Status Order Federal rule changes and other QU concepts.
• Partners with other QU Leads to coach and teach colleagues on all areas of QU and independently assists with onboarding of new staff to QU.
• Collaborates with QU Manager for onboarding and interviewing QUS candidates
• Drives creative process redesign and continuous reevaluation of effectiveness of current processes and interactions with key stakeholders
• Remains flexible in assignment coverage which includes working in routine Quality Utilization operations and in the nonEmergency Department environment as needed and at the direction of the Quality Utilization Leadership Team. This also includes flexibility of weekend coverage and nontraditional office hours.
• Remains competent in the following areas regardless of payor type: utilization review criteria observation carve outs inpatient/observation reviews and denials prevention strategies.
• Complies with Northwestern Memorial Hospital policies on patient confidentiality including HIPPA requirements and Personal Rules of Conduct.

#INDC

Qualifications :

Required:

• Registered Nurse in the State of Illinois
• Bachelors degree in Nursing
• 2 years of experience in Quality Utilization Specialist position or related role
• Mastery of utilization management and level of care guidelines
• Demonstrated leadership skills or project management
• Proven expert in conflict resolution
• Statistics quantitative and analytic skills relevant to the role
• Analytical skills necessary to independently collect analyze and interpret data resolve problems requiring innovative solutions and to negotiate in sensitive situations.          
• High level of energy and enthusiasm; flexible/adaptable ability to work with diverse group of healthcare professionals in a matrix environment
• Effective problem solving and multitasking verbal and written communication skills
• Intermediate computer skills including word processing and spreadsheets and entire Microsoft Office suite

Preferred:

• 5 years of relevant experience
• Masters Degree in Nursing

Additional Information :

Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age sex race color religion national origin gender identity veteran status disability sexual orientation or any other protected status.

Remote Work :

No

Employment Type :

Fulltime