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CM Utilization Management Nurse

4 months ago

Madison, United States GROUP HEALTH COOP- SOUTH CENTRAL WI Full time

JOB REQUIREMENTS: CM Utilization Management Nurse Administration - 1265 John Q. Hammons Drive, 1265 John Q. Hammons Dr. , Madison, Wisconsin, United States of America Req #1861 Tuesday, June 18, 2024 Group Health Cooperative of South Central Wisconsin. BETTER TOGETHER Using a collaborative process, the Care Management (CM) Utilization Management Nurse (RN) will review, plan, implement, monitor, and evaluate the options and services required to meet an individual\'s health needs, using communication and available resources to promote quality, and cost-effective outcomes. He/she helps identify appropriate providers and facilities throughout the continuum of services while ensuring that available resources are being used in a timely and cost-effective manner while maintaining quality of care. The CM Utilization Management Nurse (RN) is responsible for evaluating the medical appropriateness, quality, and cost effectiveness of proposed services in accordance with established criteria. This review activity may be conducted prospectively, concurrently, or retrospectively and in collaboration with patients, practitioners, and other professionals. The incumbent plays an integral role in working with the RN and Social Work Case Managers on an ongoing basis and providing support. The incumbent provides support and is a resource for the Care Management Associates and other staff. Work is performed under the general direction, guidance, and supervision of the Care Management Department Manager. The Utilization Management Nurse knows and abides by all Group Health Cooperative of South Central Wisconsin (GHC-SCW) organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner.The incumbent understands our Mission, Vision and Common Values (stated below) and is committed to promote these values in behavior and attitude. Our Mission Statement: We partner with members and the communities we serve to maximize health and well-being. Our Vision: As a local, not-for-profit, member-owned Cooperative, we are the most trusted resource for lifelong health and well-being in the communities we serve. Our Values: We are a not-for-profit Cooperative We are member-centered We are equitable and inclusive We are quality-driven We are innovative We are community involved GHC-SCW is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is... For full info follow application link. Group Health Cooperative is an Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status or disability. ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/D4A2B750D7B047D4