Manager, Utilization Management Nurse

Overview

Job Description Under the direction of the Utilization Management (UM) Director, UM Manager directs and supervises the UM Review Nurses and other staff as assigned. Ensures that inpatient concurrent review and retrospective review requests are performed using nationally recognized guidelines approved criteria or other evidence-based criteria. Provides leadership in Health Services programs, operations, projects, policies and procedures to ensure high quality results. As part of management, this position assists and collaborates with others throughout the organization to assure achievement of organizational and departmental goals. Required skills & experience (the “must haves” to be considered) -Bachelor of Science degree in Nursing -At least 5-7 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 required -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 to include InterQual and/or MCG (Milliman) guidelines What you need to know -onsite gym free to employees -Great base salary with bonus potential, benefits and PTO allowance -.2 miles away from the Oak Brook Mall

Benefits

Company

Helping providers succeed by developing strong relationships, delivering innovative solutions and driving exceptional performance. We were founded to enable physicians to engage, support, and manage new value-based savings and shared-risk models. We combine deep industry experience, focused technology, and innovative programs to deliver a timely, turn-key solution for healthcare providers, health plans, and strategic partners.