What are the responsibilities and job description for the Utilization Management and Population Health Nurse position at Humboldt Park Health?
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
Education
Required
Bachelors or better
Licenses & Certifications
Required
RN License
Salary.com Estimation for Utilization Management and Population Health Nurse in Chicago, IL
$72,209 to $89,642
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