Nurse Liaison I - UM & QR

Job ID: CH-1017740 Description:

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.

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can email us here to request reasonable accommodations.

Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "my account" and click on "View your job submissions".

BASIC FUNCTION:

This position is responsible for ensuring compliance of the Utilization Management (UM) and Quality Improvement (QI) 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 transplant requests and benefit terminations.

JOB REQUIREMENTS:

  • Registered Nurse (RN) with unrestricted license.
  • 3 years clinical experience with 2 years experience in utilization management, quality assurance, or statistical research.
  • Clinical knowledge, knowledge of the UM/QI process, and knowledge of managed care principles.
  • Analytical, verbal and written communications skills.

LI-POST

  • CA
  • CB*

Requirements: Expertise Other Job Type Full-Time Regular Location IL - Chicago


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