Clinical Case Manager - CORE - Grant Funded
Cook County Health is seeking a Clinical Case Manager (HRSA Part A, C, D) to support efficient inpatient care at John H. Stroger Hospital. Shift: 8:00 AM – 4:00 PM.
Job Summary
Uses knowledge of disease processes, health care delivery and financing to support effective, efficient inpatient care while acknowledging patient/family preferences, treatment requirements and self‑care capabilities to determine an appropriate discharge plan. This grant‑funded position falls under the (Grant 2025 CCH HIV SVCS-POP CENT H H‑HRSA) and will expire 07‑31‑2026, with potential renewal.
Typical Duties
Perform admission review, including assessment of patient status and determination of medical necessity.
Validate pay source and physician orders.
Collaborate with social work to determine discharge‑planning approach.
Review cases with unchanged payer status; notify manager of incomplete or denied reviews.
Reassess patients as clinically indicated or payer‑required.
Document authorizations and case notes per departmental policy.
Present concise reviews during rounding.
Identify quality concerns and report to supervisor.
Engage physicians on medical necessity, discharge disposition, and alternatives.
Participate in quality improvement activities, pilots, and workgroups.
Minimum Qualifications
Registered Professional Nurse in the State of Illinois.
Three (3) years of experience as a RPN in outpatient care or a patient‑centered medical home.
Preferred Qualifications
Bachelor of Science in Nursing from an accredited institution.
Experience with administering medical necessity criteria.
Experience with care management for patients with multiple chronic disease and acute illness.
Accredited Case Manager (ACM) or Certified Case Manager (CCM).
Bilingual skills in English/Spanish or English/Polish.
Knowledge, Skills & Abilities
Knowledge of managed care, Medicare, Medicaid, and admission review processes.
Strong interpersonal skills for a culturally diverse patient population and collaboration with physicians, nurses, therapists, social workers and insurance representatives.
Ability to adopt others’ viewpoints to facilitate patient‑centered goal setting.
Workflow streamlining, sound judgment, prioritization, planning and organization.
Multi‑tasking, managing competing priorities, and meeting deadlines in a fast‑paced environment.
Attention to detail; basic Office Suite skills (Outlook, Excel, Word); strong initiative.
Benefits Package
Medical, Dental, and Vision Coverage
Basic Term Life Insurance
Pension Plan and Deferred Compensation Program
Employee Assistance Program
Paid Holidays, Vacation, and Sick Time
100% Tuition Reimbursement for nursing‑related programs
Potential eligibility for Public Service Loan Forgiveness Program (PSLF)
Veteran Preference
Honorably discharged veterans who served at least 6 months of continuous service receive preference. Must meet the minimum qualifications and identify as a veteran on the application. Submit DD‑214/DD‑215/NGB‑22 or a valid state ID/driver’s license indicating veteran status. Failure to submit documentation disqualifies preference.
Equal Opportunity and EEO Statement
Cook County Health and Hospitals System is an Equal Opportunity Employer.