Northwestern Medicine · 17 hours ago
Lead Emergency Department Quality Utilization Specialist, Case Management, Full-time, Days (Sign-on bonus eligible))
Chicago, IL
Full-time
Onsite
Mid, Senior Level
2+ years expNorthwestern Medicine is a leader in the healthcare industry committed to patient-first interactions. The Lead Emergency Department Quality Utilization Specialist is responsible for facilitating improvements in medical necessity and level of care assessments while acting as a change agent to drive quality initiatives and collaboration among clinical teams.
Emergency MedicineHealth CareHospitalMedicalNutritionRehabilitation
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 at-risk for conflict
Responsible for initiatives leading to cross-departmental 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 re-evaluate 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 non-Emergency 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
Qualification
Required
Registered Nurse in the State of Illinois
Bachelor's 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 multi-tasking, verbal and written communication skills
Intermediate computer skills including word processing and spreadsheets and entire Microsoft Office suite
Preferred
5+ years of relevant experience
Master's Degree in Nursing
Benefits
Tuition reimbursement
Loan forgiveness
401(k) matching
Lifecycle benefits
Company
Northwestern Medicine
Northwestern Medicine is the collaboration between Northwestern Memorial HealthCare and Northwestern University Feinberg School of Medicine around a strategic vision to transform the future of health care.
10001+ employees
H1B Sponsorship
Northwestern Medicine has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (75)
2024 (66)
2023 (70)
2022 (78)
2021 (35)
2020 (39)
Funding
Current Stage
Late StageTotal Funding
$25M2018-06-26Grant· $25M
Leadership Team
Howard Chrisman, MD
President and CEO
John A. Orsini, CPA
Senior Vice President and Chief Financial Officer
Recent News
2026-01-13
Near North Health
2025-12-01
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