Utilization Review Nurse

Hiring: Delegation Oversight – Clinical Audit Coordinator (RN) Location: Hybrid – Chicago, IL (3 days onsite / 2 days remote) We're seeking an experienced Registered Nurse (RN) with a background in managed care, clinical audits, and delegation oversight . Summary 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. Required Job Qualifications 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 skills 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) Preferred Experience writing policies/procedures Medicare/Medicaid and accreditation audit experience #J-18808-Ljbffr