Utilization Management and Population Health Nurse

Humboldt Park Health Careers

Chicago, Illinois

Autofill and Review

30+ days ago

Job Description

Utilization case review and application of criteria to approve initial and continued inpatient services
Identify patients in need of outreach efforts based on patient risk stratification or other defined criteria as well as defined disease management guidelines
Work with CPHO team, patient’s Primary Care Physician and all other providers of the patients’ care to develop individualized care plans
Facilitate communication with patients and care team, coordinate referrals, and promote optimal allocation of available resources
Measure progress toward goals based on clinical judgment, review of patients’ self-monitoring tools and trends in clinical data
Assess and monitor adherence to outreach and then problem-solve intrinsic and extrinsic barriers to effective patient self-management of chronic conditions
Provide educational materials and resources to patient/family and their care providers
Refer patients/families to self-management support programs as needed and communicate with care providers to ensure safe and effective care management.
Analyze clinical data to track patient outcomes to determine improvement
Triage patient phone calls for acute patient issues and counsel accordingly
Oversight and management of population health quality improvement studies to reach established targets
Interface with Commercial and Government entities on care coordination, HEDIS and other QI activities
Report to UM/QM Committee on progress toward goals and make recommendations for improvement
Other duties as assigned
Minimum qualifications must be health plan requirements, including but not limited to licensure/certification, as applicable

Numbers & Facts

Location

Chicago, Illinois

Skills

Clinical Dataunmatched
Communication Skillsunmatched
Data Analysisunmatched
Disease Prevention and Controlunmatched
Governmentunmatched
Health Planunmatched
Healthcare Effectiveness Data and Information Set (HEDIS)unmatched
Maintain Complianceunmatched
Nursingunmatched
Patient Assessmentunmatched
Patient Careunmatched
Patient Educationunmatched
Primary Careunmatched
Problem Solving Skillsunmatched
Quality Managementunmatched
Resource Managementunmatched
Riskunmatched
Team Playerunmatched
Telephone Triageunmatched
Training/Teachingunmatched
Utilization Managementunmatched

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