Order Management Unit RN

Summary

Join Northwestern Medicine as an Orders Management Unit RN and contribute to our patient-first approach. Collaborate with the department manager to set goals, maintain strong customer relations, and ensure compliance with regulations. Responsibilities include managing outpatient orders, verifying medical necessity, collaborating with clinical departments, educating physicians, and participating in process improvement projects. This role requires a Registered Nursing license in Illinois, a Bachelor of Science in Nursing, and at least five years of related experience. Preferred qualifications include a thorough financial healthcare background and relevant certifications. Northwestern Medicine offers competitive benefits, including those related to health, retirement, paid time off, and professional development.

Requirements

• 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

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

Preferred Qualifications

• Thorough financial healthcare background preferred
• Accredited Case Manager and/or Clinical Coding and Documentation Specialist

Benefits

• 401(k) matching
• Tuition reimbursement
• Loan forgiveness
• Lifecycle benefits