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Oak Brook

    Lead Utilization Management Nurse - Oak Brook, United States - First Match Services, Inc.

    First Match Services, Inc.
    First Match Services, Inc. Oak Brook, United States

    3 weeks ago

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    Description

    Job Description

    Job DescriptionWe 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 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
    • 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.
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