Utilization Management and Population Health Nurse

Norwegian American Hospital; Chicago (IL); On-site; USD 90,000 - 115,000; Full time

Job summary

Norwegian American Hospital seeks a Utilization Management and Population Health Nurse to review inpatient services, coordinate outreach, and develop patient care plans in collaboration with primary care physicians and the care team.

The role emphasizes applying clinical criteria, monitoring outcomes, and guiding patients through self-management with education and referrals. Requires RN license and a bachelor’s degree, with full-time on-site duties in Chicago.

Qualifications

• Bachelor's degree required.
• RN license required.

Responsibilities

• Utilization case review and apply criteria for inpatient services.
• Identify patients for outreach based on risk strata and disease guidelines.
• Collaborate with care team to develop individualized care plans.
• Coordinate referrals and communicate with patients to optimize resources.
• Monitor patient outcomes and progress toward goals.
• Advise on barriers to self-management and assist with problem solving.
• Provide educational materials to patients and families.

Education

Bachelor's degree

Job description

Utilization Management and Population Health Nurse

Job Category : Leadership

Requisition Number : UTILI004091

• Posted : July 14, 2026
• Full-Time

Locations

Showing 1 location

Chicago, IL 60622, USA

Description

• 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

Qualifications

Education

Required

Bachelors or better.

Licenses & Certifications

Required

RN License

Equal Opportunity Employer
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