222 South Riverside Plaza, Suite 2120
Chicago, IL 60606, United States
Job Detail
Industry:
Healthcare/Medical
Total Positions:
1
Job Type:
Full Time
Salary:
81000-100000
Job Location:
Chicago, United States
Minimum Education:
Not Listed
Minimum Experience:
2 Years
Apply By:
Jun 03, 2018
Job Posting Date:
Apr 26, 2018
Job Description
Currently hiring for a Quality Nurse Liasion with a previous UM or Quality background!
*This will be a pre-dominantly office based role in the downtown office. You will be traveling 2 times a year to different assigned provider sites mostly in cook county for their seasonal audits in May and November. You will oversee 78 IPA and providers overall
Responsbilties:
*Auditing and monitoring what is going on for each IPA to ensure they are working through the CM and UM process
*Usually assigned to about 10 IPAs
*You will be send denial files and you will look them over to see if they are compliant with NCQA
*Spot checking all CM nurse files in each IPA
*Review cases and understand where the gap is for each IPA
*Coaching, educating, and consulting IPAs in the right direction
*Educate RNs on how to decrease hospitalizations and ER visits
*Working with IPAs to create inventive programs (how to decrease length of stays)
*Most of their work is on Microsoft Word, Excel, and powerpoint – not a ton of phone work
They will need to:
Be point person for IPAs to respond to about reviews
Oversight for the IPAs and understand if anything is missing and flag documentation if needed
Traveling to sites as needed to assist with audits ( twice a year in May and November)