Nurse Reviewer

Nurse Reviewer – State of Illinois

Location: Remote with on-site visits across Illinois

We are currently seeking Nurses who reside in Central Illinois - preferably in McLean and Sangamon Counties.

Position Overview

The Nurse Reviewer conducts provider compliance reviews to ensure adherence to state regulations, quality standards, and program requirements. This role includes conducting onsite visits, evaluating documentation, and determining provider compliance. The Nurse Reviewer works independently, exercises sound judgment, and provides recommendations that guide provider improvement and support statewide oversight efforts.

Duties & Responsibilities

• Build and maintain effective relationships with providers and users to support high-quality customer service.
• Evaluate providers for compliance with applicable state and program regulations.
• Coordinate and schedule on-site provider visits; clearly communicate visit requirements.
• Conduct compliance interviews with providers and gather all necessary information.
• Review provider documentation, policies, and business practices for regulatory alignment.
• Collect, organize, and submit documentation supporting compliance findings.
• Utilize technology and web-based systems to convert paper documentation to electronic format.
• Conduct in-person assessments of provider sites to evaluate compliance with oversight requirements.
• Summarize on-site visit findings accurately and professionally.
• Exercise independent judgment to evaluate compliance and make final determinations based on documented evidence.
• Identify deficiencies and recommend appropriate next steps to support provider improvement.
• Analyze trends in non-compliance and identify gaps in provider business processes.
• Provide timely recommendations and updates to the Supervisor.
• Maintain HIPAA standards and confidentiality at all times.
• Perform other duties as assigned.

Required Skills

• Strong interpersonal skills with the ability to relate well to staff and providers.
• Active listening and effective communication skills.
• Proficiency in MS Word, Excel, Outlook, and web-based applications.
• Process-oriented and results-driven work approach.
• Ability to foster teamwork and collaborate across levels of management and staff.
• Ability to work independently and within a team environment.
• Excellent written and verbal communication skills and customer-service techniques.
• High accuracy, strong attention to detail, and commitment to quality.
• Proven ability to meet deadlines and follow strict standards.
• Ability to travel regularly to provider sites across Illinois.

Qualifications

Experience

• Minimum 2 years of clinical experience working with critical care providers, public health providers, or providers serving children, older adults, individuals with traumatic brain injury, or individuals with developmental disabilities.
• Minimum 1 year of experience conducting quality assurance reviews.

Education

• Bachelor's degree preferred

Certification

• Must have an Active Illinois Registered Professional Nurse (RN) license required.

Working Conditions

• Remote work with 2–3 on-site provider visits per week throughout the state of Illinois.

Benefits (Through SSO)

• Medical, dental, and vision insurance
• 401(k) with discretionary employer match
• Paid time off and holidays
• Flexible spending accounts
• Additional employee perks