Util Review/Case Mgmt Nurse
Children's Hospital & Health System - Milwaukee, WI

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Performs utilization review and care management for CCHP members. Responsible for both utilization management review concentrating particularly on concurrent reviews and pre-authorization requests for identified services and for performing individual care management for high risk members throughout the continuum of care.

Knowledge of patient care, utilization management or case management theory required. Registered Nurse (BSN preferred) with a current WI license. One year of utilization management/case management experience and certification in utilization/case management preferred. Previous experience in care of the child/family preferred. Independent judgment, analytical ability, systems thinking and interpersonal communications necessary to work in complex systems as well as an understanding of the impact of healthcare delivery systems on the patient and family. Computer knowledge and skills in word processing required.