Job Description
Company Description
At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you’ll have the opportunity to join our quest for better health care, no matter where you work within the Northwestern Medicine system. We pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, our goal is to take care of our employees. Ready to join our quest for better?
Job Description
The Orders Management Unit RN reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards. Responsible for outpatient orders as it relates to completeness of the order, meeting medical necessity and communicating with physician offices for updated orders.
Responsibilities:
- Collaborates with the department manager to develop goals and objectives for area(s) of responsibility which are aligned with the strategic plan and/or organizational goals.
- Maintains customer relations within area(s) of responsibility with patients, families, physicians, volunteers and other employees.
- Ensures departmental compliance with regulations, statutes and other applicable laws regarding operation and record retention.
- Maintains patient satisfaction scores consistent with the organizational goal.
- Ensures that orders received are compliant with hospital and regulatory guidelines.
- Utilizes the appropriate tools to ensure the ordered service meets medical necessity requirements as defined by Medicare.
- Collaborates with clinical departments to ensure that correct Current Procedural Terminology (CPT) codes are used when checking for medical necessity on original and amended orders.
- Provides support and teaching to Orders Management Unit (OMU) staff on medical necessity and order management.
- Educates referring physicians to improve order completeness.
- Participates on clinical teams designed to streamline and automate outpatient order process.
- Tracks pending orders and MD queries to ensure timely follow through.
- Develops and maintains a proactive communication matrix with identifiable problem-solving feedback loops with Department manager.
- Documents focus study trends, processes and other issues surrounding Charge master Referrals
- Resource for ABN/waivers within the organization.
- Issues and discusses ABNs/waivers to patients, either in person or via telephone respecting patient privacy.
- Communicates with ordering physicians medical necessity issues and ABNs/waivers issued.
- Performs denial management for infusion cases.
- Quality review as evidenced by process improvement projects and documentation assessment for Quality Indicators.
- Serves as a resource for physician offices regarding regulatory standards, policies and procedures for outpatient orders.
- Serves as a resource for Registration, Scheduling, and Clinical Departments for order completeness, policies and procedures for outpatient orders, medical necessity issues, and regulatory standards.
- Assists in processing orders received during high volume times.
- Maintains hospital-wide behavioral expectations of Excellence, Integrity, Respect, Teamwork and Innovation.
Qualifications
Required
- Registered Nursing license issued by the State of Illinois.
- Bachelors of Science Nursing
- At least five years of related work experience or training or equivalent combination of education and experience.
Preferred
- Thorough financial healthcare background preferred.
- Accredited Case Manager and/or Clinical Coding and Documentation Specialist
Additional Information
Northwestern Medicine is an equal opportunity employer (disability, VETS) 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.
Background Check
Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check. Results are evaluated on a case-by-case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.
Artificial Intelligence Disclosure
Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.
Benefits
We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events.
Click on or copy and paste URL to your browser to view detailed benefits information https://jobs.nm.org/benefits
Please refer to the Benefits Eligibility by Employment Classification to determine benefits eligibility for job postings.
If sign-on bonus is included in a job posting eligibility is as followed: Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign-on bonus. Exception: New graduate internal employees seeking their first licensed clinical position as a Registered Nurse at NM may be eligible.
