Lead Utilization Management Nurse

Job Description

Job Description

We 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

ADDITIONAL DETAILS