Nurse Liaison I - UM & QR

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 unrestricted license.

• 3 years clinical experience with 2 years experience in utilization review, quality assurance, 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.

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


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