Utilization Management Lead-Utilization Review Full Time Days

Northwestern Memorial Healthcare•Palos Heights, IL

1d•Onsite

About The Position

The Utilization Management Lead reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards. This role serves in a lead capacity, fostering interdisciplinary relationships, managing conflict, coaching, mentoring, and developing staff. The lead ensures a supportive environment for the utilization review team and acts as an expert in utilization management, collaborating on evidence-based practice implementation. They are responsible for identifying customer needs, gathering feedback, implementing solutions, and translating organizational vision into unit-level goals to improve employee performance and engagement. The lead also encourages the sharing of new ideas and best practices and maintains active membership in professional organizations.

Requirements

Graduate of an accredited school of nursing with a BSN
Minimum of three years of case management experience in an acute care setting or health care environment.

Nice To Haves

ACM certification
Masters Degree

Responsibilities

Collaborates with the director of care coordination to oversee the utilization Review and Management process in accordance with NM UM Plan and operations of the UR team.
Serves in a lead role by utilizing communication skills to build trusting interdisciplinary relationships; engaging in conflict management, coaching, mentoring, and staff development; fosters an environment for shared decision making.
Collaborates with the director of care coordination to provide the utilization review team with an environment that supports their professional practice, health and well-being.
Serves as the Utilization Management expert and collaborates with the director of care coordination for the implementation of evidence-based practice.
Clearly identifies the internal and external customer(s) for their unit or service area and their respective requirements/expectations.
Actively seeks methods of concurrent and retrospective feedback from customers, listens to customer feedback and implements solutions and/or interventions as appropriate.
Continually examines ways to improve business relationships with customers, suppliers, and the community.
Translates organizational vision into a unit or service area vision that engages team members in contributing to and achieving that vision.
Provides feedback to improve employee performance and engagement.
Seeks new ideas from a wide range of sources; encourages others to share knowledge and best practices.
Maintains active membership in Professional Organization and shares current, relevant information