Utilization Specialist - Licensed RN at AltaStaff in Chicago, IL
We are a boutique agency recruiting for an experienced Licensed RN to work in the Utilization Management division of a national, health insurance firm located in downtown Chicago.
- Conduct medical record review/audits to evaluate compliance with standards and outcomes (e.g., quality, accuracy and timeliness)
- Monitor/track compliance with customer and regulatory requirements
- Report results and make recommendations (e.g., performance improvement projects, quality improvement activities, improvement action plans)
- Perform special reviews as requested, including focused studies of clinical care
- Benefits Management/Promoting Health Information Technology/FOUNDATION
- General Business/Demonstrating Business and Industry Acumen/FOUNDATION
- Leadership/Creating Accountability/ADVANCED
- Medical Records Review
- Produce meaningful reports for various QM committees
- Communication with members who are part of Medicaid managed care. Medicaid experience preferred. Managed care desired.
- Interaction with physicians and office staff
- HEDIS experience
EDUCATION: Associates degree or equivalent experience.
LICENSES AND CERTIFICATIONS: Nurses/Registered Nurse (RN) required
FUNCTIONAL EXPERIENCES: Administration / Operations/Document production & distribution/1-3 Years