Clinical Utilization Manager

7 days ago

Rolling Meadows, Illinois, United States Advocate Aurora Health Full time
Job Summary

We are seeking a highly skilled Clinical Utilization Manager to join our team at Advocate Aurora Health. As a key member of our utilization management team, you will play a critical role in ensuring that our patients receive the most appropriate level of care while minimizing unnecessary costs.

Key Responsibilities
  • Perform telephonic utilization management for network and non-network hospital admissions to ensure appropriate admissions and level of care.
  • Collaborate with primary care physicians, hospitalists, specialists, and medical directors to clarify treatment plans and goals.
  • Review questionable stays with medical directors and coordinate necessary letters, notifications, and documents to comply with utilization and/or denial policy.
  • Facilitate safe and timely discharges from the hospital to alternative levels of care, such as skilled nursing facilities or home care.
  • Screen all cases for designated quality indicators and report questionable situations to the manager.
  • Comply with all necessary documentation requirements to meet regulatory agency requirements.
Requirements
  • Registered Nurse license issued by the state in which the team member practices.
  • Bachelor's Degree in Nursing.
  • Typically requires 3 years of experience in a clinical role with at least one year of previous utilization review, discharge planning, or case management experience.
Preferred Qualifications
  • Ability to handle multiple tasks and intervene in difficult situations.
  • Good verbal and written communication skills, with excellent interpersonal communication and problem-solving skills.
  • Ability to work independently and prioritize assignments, using independent judgment and discretion.
About Advocate Aurora Health

Advocate Aurora Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia, and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience, and value-based care.

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