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 .
We are hiring for an MA to join a busy and well established clinical research clinic to assist with Neurology patients. This position is 100% onsite, clinical research experience is NOT required. Apply today! Important: This position is a contract, thus possibility...
...Director. About the Opportunity: Schedule: Monday to Friday Hours: Standard business Specialty: Interventional Cardiology Responsibilities: As the Medical Director for the Cardiac Cath Lab, the Physician is responsible for the operational...
Job Overview An Interior Kitchen and Bath Designer specializing in residential remodeling transforms existing kitchen and bathroom spaces in homes to enhance functionality, safety, and aesthetics. This role centers on reimagining and revitalizing clients living environments...
...properties in Greece. We specialize in luxury real estate across the Athens Riviera, Glyfada, Voula, Vouliagmeni, Crete, Mykonos and other Greek islands. We work directly with developers, construction companies and private property owners. The brand is supported by TERAMOK LLC...
.... Education, License & Cert: High School Grad or Equivalent preferred. Experience: Advanced Certification or training (i.e. LPN, Crisis Training, Tech) Constant Observation or One to One observation experience preferred, but not necessary. Essential Functions...