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Nurse Liaison I UM & QR
Nurse Liaison I UM & QRIntegrated Resources, Inc ( IRI ) • Naperville, IL, United States
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Nurse Liaison I UM & QR

Nurse Liaison I UM & QR

Integrated Resources, Inc ( IRI ) • Naperville, IL, United States
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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.
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    Nurse Liaison • Naperville, IL, United States