Job Description

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.

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

Qualifications

Required

• 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.

Preferred

• ACM certification, Masters Degree

Equal Opportunity

Northwestern Medicine is an equal opportunity employer (disability, VETS) and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.

Background Check

Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check. Results are evaluated on a case-by-case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.

Artificial Intelligence Disclosure

Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.

Benefits

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.

Sign-on Bonus Eligibility (if sign-on bonus offered for position): Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family.