CM Utilization Management Nurse

GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. In dedication to the health and well-being of our employees, we offer a comprehensive benefits package that includes health and dental insurance, along with paid parental leave, short-term disability, long-term disability, and life insurance. Additional benefits include a flexible spending account, employee assistance programs, tuition reimbursement, pet insurance, eyewear discounts, and more. Check us out by clicking on Many Talents, One Mission! The Benefits of Working at GHC-SCW.

Group Health Cooperative of South Central Wisconsin. BETTER TOGETHER This is a full-time role (40 hours per week). Following an initial onboarding and training period, the position will be fully remote. Candidates must be residents of Wisconsin.

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. They help 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 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. They play an integral role in working with the RN and Social Work Case Managers on an ongoing basis and providing support. They provide 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. GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. In dedication to the health and well-being of our employees, we offer a comprehensive benefits package that includes health and dental insurance, along with paid parental leave, short-term disability, long-term disability, and life insurance. Additional benefits include a flexible spending account, employee assistance programs, tuition reimbursement, pet insurance, eyewear discounts, and more. Check us out by clicking on Many Talents, One Mission! The Benefits of Working at GHC-SCW.