Nurse Liaison I - Registered Nurse (RN) - Utilization Management (UM) & Quality Review (QR)

This is an on-site position based at our Chicago Headquarters office with some field-based travel to the metropolitan area of Chicago and the Suburbs .
• This is not a patient/member-facing role.


Join us and grow your career as we do everything in our power to stand with our members in sickness and in health!

BASIC FUNCTION:


This position is responsible for ensuring compliance of the Utilization Management (UM) and Quality Review (QR) functions performed by the Medical Groups/IPAs participating in the networks of BCBSIL's HMOs. Evaluates the need for, designs, and implements educational seminars for Medical Groups/IPA staff, assists in benefit determinations, and provides support on benefit terminations and Individual Benefit Management Program (IBMP) cases.

JOB REQUIREMENTS:

• Registered Nurse (RN) with a current, unrestricted license in The State of Illinois or reciprocity.

• 3 years of clinical experience as an RN with 2 years experience in Utilization Review (UR), Quality Assurance (QA), or statistical research.

• Clinical knowledge, knowledge of the UM/QR process, and knowledge of managed care principles.

• Analytical, verbal and written communications skills.

• Current Illinois drivers license.

• Able and willing to travel, including overnight stays.
• Experience in Utilization Management (UM) and/or Case Management (CM) in a managed care setting or for an IPA.

• Prior experience creating PowerPoint presentations

• Experience presenting to and/or training large groups of 100 people or more
• CCM
• BSN
• Audit experience

•CA

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Requirements: Expertise Nursing Job Type Full-Time Regular Location IL - Chicago


Back to top