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Utilization Specialist - Licensed RN

Chicago, IL | Healthcare

Job Description

About Us:

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.

Responsibilities:

  • 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

Requirements:

  • Benefits Management/Promoting Health Information Technology/FOUNDATION
  • General Business/Demonstrating Business and Industry Acumen/FOUNDATION
  • Leadership/Creating Accountability/ADVANCED
  • NQCA
  • 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

Desired Qualification:

EDUCATIONAssociates degree or equivalent experience.

LICENSES AND CERTIFICATIONS:  Nurses/Registered Nurse (RN) required

FUNCTIONAL EXPERIENCES:   Administration / Operations/Document production & distribution/1-3 Years

 

 

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