Nurse Liaison UM Specialist

4 weeks ago


Richmond, Virginia, United States Careers Integrated Resources Inc Full time
Job Title:

Nurse Liaison UM

Job Summary:

We are seeking a highly skilled Nurse Liaison UM to join our team at Careers Integrated Resources Inc. The successful candidate will be responsible for ensuring compliance of the Utilization Management (UM) and Quality Review (QR) functions performed by the Medical Groups/IPAs participating in our networks.

Key Responsibilities:
  • Reviews and evaluates UM/QR plans for prospective and existing Medical Groups/IPAs in our networks.
  • Prepares reports on findings and communicates outcomes to Medical Groups/IPAs and management.
  • Communicates contractual requirements to medical groups, IPAs, and contract management firms, corporate headquarters.
  • Monitors UM activities of Medical Groups/IPAs to measure adherence to our UM/QR standards.
  • Coordinates with Corporate Audit department regarding Corporate site audits and related corrective action plans.
  • Designs and implements in-services, seminars, and special presentations which promote the UM/QR process.
  • Travels to medical groups and IPAs for audits and in-services.
  • Provides necessary administrative support to assist Medical Groups/IPAs with unusual benefit requests.
  • Coordinates activities of support staff.
Requirements:
  • Strong knowledge of UM and QR processes and standards.
  • Excellent communication and interpersonal skills.
  • Ability to work independently and as part of a team.
  • Strong analytical and problem-solving skills.
  • Ability to travel to medical groups and IPAs.
What We Offer:

We offer a competitive salary and benefits package, as well as opportunities for professional growth and development.

How to Apply:

Please submit your resume and cover letter to [insert contact information].



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