Vacancy expired!
Location: Chicago, IL Salary: Competitive range Description: Our client is currently seeking a NURSE LIAISON I UM & QR
Remote BUT Candidates must be in the Chicago HQ area in case they need to be onsite for meetings This job will have the following responsibilities:- This position is responsible for leading, coordinating and participating in clinical delegation oversight audits of Client's vendors, service providers, medical groups and/or delegated subcontracted providers reviewing adherence to regulatory and contractual requirements.
- The position also develops audit tools based on state and federal regulations, conducts the reviews in accordance with accreditation standards and clinical guidelines.
- Creates reports regarding audits, and analyzes, tracks and trends audit findings.
- Develops and monitors corrective actions and provides feedback to practitioners on performance.
- May support in drafting amendments to agreements.
- Registered Nurse (RN), unrestricted license to practice in state.
- 3 years managed care experience or health plan operations experience.
- Experience developing and analyzing reports.
- Experience in performing delegation oversight and monitoring multiple delegated functions, state and products.
- Experience interpreting and implementing accreditation standards (NCQA and URAC).
- Experience to interpret and implement state and federal health insurance regulations.
- Organizational, verbal and written communications skills to include delivering presentations to committees and acting as company representative to subcontractor management (Vendors and Delegates).
- PC experience to include Microsoft Office suite of applications (Word, Excel).
- Able and willing to travel, including overnight stays (approximately 30 days of overnight travel annually).
Vacancy expired!