RN Director Of Care And Utilization Management

The Clinical Recruiter Naperville , IL 60540

Posted 2 months ago

RN Director of Care and Utilization Management Chicago

  • Naperville

  • Joliet, Illinois Summary:
    Reports to the Executive Director responsible for developing, coordinating and directing and care management initiatives.
    Works collaboratively with the Medical Director of Population Health, Staff, and its participating physician and allied health providers in the development of standardized clinical evidence-based guidelines and care management systems.
    Responsible for implementing and integrating clinical evidence-based guidelines and care management systems across continuum of care.
    The Director will also be responsible for developing the systems and processes to achieve results in support of the Quadruple Aim: Quality, Cost, Experience and Satisfaction.

    Responsibilities: - Provides overall direction, design, development implementation and monitoring of utilization programs to meet the Hospital's utilization goals while maintaining customer satisfaction
  • Acts as a resource to the medical staff, administrative staff, divisional, and external regulatory agencies in all issues relating to utilization management

  • Oversees outside medical services based on Health Plan benefit guidelines and medical necessity

  • Analyzes and reports significant utilization trends, patterns, and impact to appropriate departmental and medical staff committees

  • May direct the operations of outside referrals/transportation services

    - BSN or bachelor's degree in health care related field such as management, health services administration
  • Illinois RN License required

  • Three to five years' experience in Population Health Management

  • Demonstrated knowledge of operations and healthcare management; TJC, Title XXII, Medicare, Medi-Cal and other local, state and federal regulations

  • Knowledge of managed care operations

  • Demonstrated interpersonal, negotiation, and leadership skills

  • Effective oral and written communication skills

  • Must be able to work in a Labor/Management Partnership environment For all of our Case Management opportunities, please forward a resume to Otie Pruett at or visit our Case Management website at If this opportunity is of interest, please feel free to contact me at your earliest convenience.
    If there is someone that you know who may be interested in this opportunity, I would appreciate the referral.
    Otie Pruett VP of Case Management Recruitment Email: Direct:

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RN Director Of Care And Utilization Management

The Clinical Recruiter