Utilization Management and Population Health Nurse

About Humboldt Park Health As a community-based hospital, Humboldt Park Health reinvests in the community through programs that serve the poor and uninsured, manage chronic conditions such as diabetes, provide health education, and promote initiatives and outreach for older adults. We work hard every day to be a place of healing, caring, and connection for the patients and families in the community we call home. Since its founding in 1894, Humboldt Park Health has been deeply committed to serving the Humboldt Park community. Humboldt Park Health is a 200-bed acute care facility providing patient-centered healthcare services focused on quality and compassionate care, ranging from everyday healthcare needs to treatment for the most critical conditions. Join a Team That Cares for You, Too Caring for others starts with supporting the people who make it possible. We are committed to supporting our employees with meaningful benefits, retirement planning support, and opportunities for continued growth and development. Whether you are seeking a full-time, part-time, or Registry position, you will be part of a compassionate, team-oriented environment dedicated to caring for both our patients and our staff. Benefits Benefits eligibility and offerings vary based on employment status and applicable plan requirements. Eligible employees may have access to: Medical, dental, and vision coverage Employer-paid life and AD&D insurance Flexible Spending Account (FSA) options 403(b) retirement plan with employer match, subject to eligibility requirements Paid Time Off (PTO), which may increase with years of service Employee discount at the Humboldt Park Health Wellness Center Education reimbursement, subject to eligibility requirements Employee wellness programs Additional voluntary benefits Opportunities for additional shifts, where applicable Benefits, eligibility, and employer contributions are subject to the applicable plan documents, employment status, and organizational policies. Position Summary The UM/Population Nurse is a health professional and possesses an active, unrestricted IL professional license, and is responsible for the day-to-day utilization review activities. The UM/Population Nurse of Care Coordination and Quality Improvement is responsible for the oversight and management of all aspects of care coordination and quality improvement activities for identified Century PHO enrollees, including but not limited to, identification of at risk patients and assisting them with navigating the continuum of care to achieve optimal clinical outcomes. Essential Duties and Responsibilities: Utilization case review and application of criteria to approve initial and continued inpatient services Identify patients in need of outreach efforts based on patient risk stratification or other defined criteria as well as defined disease management guidelines Work with CPHO team, patient’s Primary Care Physician and all other providers of the patients’ care to develop individualized care plans Facilitate communication with patients and care team, coordinate referrals, and promote optimal allocation of available resources Measure progress toward goals based on clinical judgment, review of patients’ self-monitoring tools and trends in clinical data Assess and monitor adherence to outreach and then problem-solve intrinsic and extrinsic barriers to effective patient self-management of chronic conditions Provide educational materials and resources to patient/family and their care providers Refer patients/families to self-management support programs as needed and communicate with care providers to ensure safe and effective care management. Analyze clinical data to track patient outcomes to determine improvement Triage patient phone calls for acute patient issues and counsel accordingly Oversight and management of population health quality improvement studies to reach established targets Interface with Commercial and Government entities on care coordination, HEDIS and other QI activities Report to UM/QM Committee on progress toward goals and make recommendations for improvement Other duties as assigned Minimum qualifications must be health plan requirements, including but not limited to licensure/certification, as applicable Current RN licensure