Nurse Liaison I UM & QR

Job Title : Nurse Liaison I UM & QR Location : Naperville, IL Duration : 6 months (possible extension) Schedule : 40hr, Mon- Fri, 8a - 4 : 30p Pay Rate : $41.00 / hr. on w2 Job Summary : 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 Client'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 : 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. 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. 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. Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested. 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.