Utilization Management and Population Health Nurse

Humboldt Park Health

Chicago, IL

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JOB DETAILS

SKILLS

Clinical Data, Communication Skills, Data Analysis, Disease Prevention and Control, Government, Health Plan, Healthcare Effectiveness Data and Information Set (HEDIS), Maintain Compliance, Nursing, Patient Assessment, Patient Care, Patient Education, Primary Care, Problem Solving Skills, Quality Management, Resource Management, Risk, Team Player, Telephone Triage, Training/Teaching, Utilization Management

LOCATION

Chicago, IL

POSTED

Today

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

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

Utilization Management and Population Health Nurse

Humboldt Park Health

Chicago, IL

About the Company

Humboldt Park Health

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