Utilization Management and Population Health Nurse

Humboldt Park Health Careers

  • Chicago, Illinois
  • 30+ days ago

    Highlights

    Refer patients/families to self-management support programs as needed and communicate with care providers to ensure safe and effective care management. Assess and monitor adherence to outreach and then problem-solve intrinsic and extrinsic barriers to effective patient self-management of chronic conditions.

    Numbers & Facts

    LocationChicago, Illinois

    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

    Similar Jobs

    See more jobs