We have an innovative organization looking to add a Lead Utilization Management Nurse to its team. Their main purpose is to enable physicians to engage, support, and manage new value-based savings and shared-risk models. They deliver timely, turn-key solutions for healthcare providers, health plans and strategic partners.
In this position as the Lead Utilization Management Nurse you will provide expertise in Utilization Management while managing a small team of UM nurses to help ensure that every patient receives the right type of care, at the right time in the right setting, every day! You will also provide hands-on expertise to help implement company strategies and provide oversight of assigned IPA Utilization Management program.
Some other responsibilities include:
Conducting monthly client UM Committee meetings
Act as a resource for the UM Nurses (first point of contact for clinical clarification/education)
Participate in data analysis of utilization metrics
Prepare, participate and present summary utilization management reports to UM/QM Committee
Much More!
QUALIFICATIONS
Bachelor of Science degree (AND or BSD) in Nursing
At least 4-5 years of relevant professional experience, including medical management experience in health plans, provider, or MSO settings and quality chart reviews
Registered Nurse (RN) with a current and active nursing license to practice in the State of Illinois is requiredÂ
A minimum of three (3) years of responsible leadership experiences in management positions
Certified Case Manager (CCM) preferred
Knowledge/experience in Medicare/Medicaid and HEDIS criteria is highly desirable
Valid Driver's License and vehicle required
Ability to travel at least 30% for client meetings within the state required
ADDITIONAL DETAILS
On-site gym FREE to employees
On-site deli
Professional Development Opportunities
Great base salary with bonus potential
Full benefits, 401k and PTO allowance
Eligible for consideration of partial work from home status upon completion of probationary period as designated by the direct supervisor.