Remote work from Illinois, Wisconsin, Indiana, and Iowa
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.
Hours are: 7:30am-4pm Monday-Friday
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
Equal Opportunity
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.
If we offer you a job, we will perform a background check that includes a review of any criminal convictions. A conviction does not disqualify you from employment at Northwestern Medicine. We consider this on a case-by-case basis and follow all state and federal guidelines.
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. Please visit our Benefits section to learn more.
