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Lead Utilization Management Nurse

1 month ago

Oak Brook, Illinois, United States First Match Services, Inc. Full time
Job SummaryFirst Match Services, Inc. is seeking a highly skilled Lead Utilization Management Nurse to join our team. This role is responsible for providing expertise in Utilization Management while managing a small team of UM nurses. The successful candidate will have a strong background in nursing and experience in medical management, with a focus on quality chart reviews and data analysis.

Key Responsibilities
  • Conduct monthly client UM Committee meetings to ensure effective communication and collaboration.
  • Act as a resource for the UM Nurses, providing clinical clarification and education as needed.
  • Participate in data analysis of utilization metrics to inform business decisions.
  • Prepare and present summary utilization management reports to the UM/QM Committee.
  • Other responsibilities include conducting quality chart reviews, participating in data analysis, and preparing reports.

Requirements
  • Bachelor of Science degree in Nursing (AND or BSD).
  • At least 4-5 years of relevant professional experience, including medical management experience in health plans, provider, or MSO settings.
  • Registered Nurse (RN) with a current and active nursing license to practice in the State of Illinois.
  • A minimum of three (3) years of responsible leadership experience in management positions.
  • Certified Case Manager (CCM) preferred.
  • Knowledge/experience in Medicare/Medicaid and HEDIS criteria is highly desirable.
  • Valid Driver's License and vehicle required.
  • Ability to travel at least 30% for client meetings within the state required.

What We Offer
  • On-site gym FREE to employees.
  • On-site deli.
  • Professional Development Opportunities.
  • Great base salary with bonus potential.
  • Full benefits, 401k and PTO allowance.
  • Eligible for consideration of partial work from home status upon completion of probationary period as designated by the direct supervisor.