NI-Care Manager

J  o  b    D  e  s  c  r  i  p  t  i  o  n

JOB INFORMATION

Effective Date:

6/15/2025

Entity:

Illinois

Job Code:

NI-2014AC

Job Title:

NI-Care Manager

Exemption Status:

Exempt

JOB SUMMARY

Leads the Care Management Team, providing comprehensive nursing assessment of patients including planning, implementation, coordinating, monitoring, and evaluation of a plan of care. The plan of care will have an emphasis on communication, facilitating transitions across the continuum of care, and aligning resources within the community or health system in order to meet population needs. Monitors admissions establishing medical necessity, ensuring the appropriate level of care and facilitating the transition to an alternate post-acute care setting when appropriate. Coordinates care by leading daily patient rounds and coordinating the communication among nurses, ancillary staff and physicians. Communicates with nurses and physicians regarding core measures and other evidence-based practice compliance. In conjunction with the patient, support network, and members of the multidisciplinary team, focuses on daily goals and outcomes and formulates an appropriate discharge plan. Participates in continuous quality improvement activities and educational experience in support of departmental and divisional nursing philosophy and objectives as well as Health System population health initiatives.

MAJOR RESPONSIBILITIES

•

In conjunction with physicians, nursing staff and other health care professionals works to improve the quality of patient care and ensure the efficient and cost effective movement of patients through the health care continuum. Transitions patient to an appropriate level of care as soon as clinically indicated, seeking alternatives to avoid medically unnecessary stays.

•

Reviews and monitors inpatient and observation patient medical records for appropriateness of admission and continued stay utilizing Interqual criteria and identifying problems in utilization. Refers utilization problems to Executive Health Resources per contracted requirements for review and resolution. Refers unresolved UR issues to medical staff leadership as needed.

•

Coordinates daily care rounds, care conferences, referrals, discharge planning and other resources based on individual patient needs. Appropriately documents case management activity maintaining confidentiality of position acquired information.

•

Monitors compliance with Medicare law and issues follow up Important Message notices on Medicare patients as required. Facilitates appeal process and follow up.

•

Monitors patient records for quality concerns and addresses with medical, nursing, or leadership staff as needed. Refers potential litigation problems to Risk Management. Participates in the development of clinical pathways, CQI or other problem solving teams as appropriate.

•

Conducts individualized assessment of patient discharge needs, develops and implements an appropriate plan in collaboration with community agencies, patient, their support system, physicians, and nursing and other multidisciplinary team members.

•

Participates in any disease-specific activities that are a focus of the assigned nursing unit. Provides educational programs and presentations as requested for medical and hospital staff sharing knowledge, information or regulation updates.

ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS.

X

Clinical

Provides age and culturally appropriate assessment/screening, interpretation of clinical and laboratory data and develops and implements age appropriate interventional and plans of care including education within the parameters of his/her position responsibilities and licensure.

JOB REQUIREMENTS

Graduate of an accredited Bachelor of Science in Nursing (BSN) program or equivalent combination of education and experience. In lieu of a BSN, an Associate Degree in Nursing (ADN) with 2 years of relevant equivalent experience will be accepted.

Required

Current Registered Nurse licensure from the Illinois Department of Professional Registration.

Required

Annual BLS certification.

Required

Care Management certification.

Preferred

•

Successful completion of annual age and job specific competencies and skill validation tools.

•

Good interpersonal skills and ability to relate well with all levels within the organization and community.

•

Flexibility and excellent verbal, written, organizational and critical decision-making skills.

•

Ability to analyze and evaluate information from multiple sources.

•

Demonstrated ability to consider the specific needs of different age groups in all interactions.

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

Standing

X

Walking

X

Climbing

X

Bending

X

Crouching

X

Pushing / Pulling

X

Carry

X

Fine Hand / Eye Coordination

X

Color Discrimination

X

Hearing Ability

X

Lifting / Lowering 1 -15 lbs.

X

15 - 30 lbs.

X

Over 50 lbs.

UW Health does not require, nor does it expect that its employees lift more than 50 lbs unassisted. Objects in excess of 50 lbs should be lifted or moved with mechanical means or through a team lift. Employees in patient care areas are expected to utilize mechanical lifts and adhere to the "Use of Mechanical Lifts (Liko)" policy in the Patient Services Policy and Procedure Manual.

Concentration on Detail

X

Attention Span of 1 + Hours on a Task

X

Ability to Remember Multiple Tasks

X

Oral Communication

X

Written Communication

X

Exposure to Blood and Body Fluids

X

Exposure to Toxins, Cytotoxins, Poisons

X

Exposure to Extreme Heat, Cold, Temp Fluctuations

X

Exposure to Hazardous Chemicals

X

Exposure to Radiation

X

Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.