Job Title: Nurse Liaison | UM&QR
Location: Naperville IL | Hybrid
Duration: November 2025 to June 2026 (possible extension)
Pay: $41.00/hr on W2
#of Openings: 4
Position: Clinical Delegation Coordinator
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 transplant requests, benefit terminations and Individual Benefit Management Program (IBMP) cases.
ESSENTIAL FUNCTIONS:
1. Reviews and evaluates UM/QR plans for prospective and existing Medical Groups/IPAs in the HMO networks. Prepares reports on findings and communicates outcomes to Medical Groups/IPAs and HMO management.
2. Communicates contractual requirements to medical groups, IPAs, and contract management firms, corporate headquarters including but not limited to utilization management, quality review, clinical, and non-clinical quality improvement.
3. Monitors UM activities of Medical Groups/IPAs to measure adherence to HMO UM/QR standards by conducting annual UM/QR audits. Evaluates results, prepares reports on findings, and communicates outcomes to Medical Groups/IPAs and HMO management.
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 driver’s license.
? Able and willing to travel, including overnight stays .
...Title: Travel Certified Nursing Assistant Location: Eatontown, NJ 07724 Term: Contract: 7 weeks Shift: 07:00 am - 03:00 pm Start: ASAP Requirements: Must be certified as a nursing assistant Must have BLS/CPR Experience with...
...contractor or heavy civil environment. Required Expertise: Technical Foundation: Deep knowledge of site development, earthwork, grading, utilities, topography, and rock excavation/blasting. Financial Acumen: Confidence in managing complex bids, budgets, and cost...
Company Description Boyd Gaming Corporation has been successful in gaming jurisdiction in which we operate in the United States and is one of the premier casino entertainment companies in the United States. Never content to rest upon our successes, we will continue ...
...sahre our passion for cycling and our belief in a fair society. POSITION DESCRIPTION We are looking for a full-time Customer Service Specialist. You are passionate about excellent and timely customer service, and will be supporting our dealer network, sales...
...roofing contractor nationwide, Guy Roofing is seeking a National Sales Representative to join our Spartanburg, SC headquarters. This... ...Responds to requests from customers for information and gives online presentations. Attend trade shows up to twice per year. Engages...