RN-Registered Nurse -Manager of Utilization Management
Nurse Resolutions - Oak Brook, IL

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Position Purpose:
Perform duties to conduct and manage the day-to-day operations of the utilization management function. Communicate with staff to facilitate daily department functions.

Position Responsibilities:
Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives.

Promote compliance with federal and state regulations and contractual agreements.

Develop, implement and maintain compliance, policies and procedures regarding medical utilization management functions.

Develop, implement, and maintain utilization management programs to facilitate the use of appropriate medical resources and decrease health plan financial exposure.

Compile and review multiple reports on work function activities for statistical and financial tracking purposes to identify utilization trends and make recommendations to management.

Facilitate on-going communication between utilization management staff and contracted providers.

Develop staff skills and competencies through training and experience.

License/Certificates: Current state registered nursing license. Case Management Certification preferred.

Bachelor’s degree in nursing preferred. 3 – 5 years utilization management and recent nursing experience in an acute care setting particularly in medical/surgical, pediatrics, or obstetrics and management experience. Prefer Behavioral Health Experience. Thorough knowledge of utilization management and clinical nursing. Familiarity with Medicare and Medicaid managed care practices and policies, CHIP and SCHIP.

License/Certificates: Current state registered nursing license. Case Management Certification preferred.

Abe Ghebrehiwet
Senior Account Executive
Nurse Resolutions
888.411.2228. Toll Free
407.341.9647. Cell
407.982.7508. Fax

case manager, case management, utilization review, utilization management, managed care, oak brook, chicago, illinois