What are the responsibilities and job description for the Utilization Review Nurse position at Integrated Resources, Inc ( IRI )?
Hiring: Delegation Oversight – Clinical Audit Coordinator (RN)
📍 Location: Hybrid – Chicago, IL (3 days onsite / 2 days remote)
🕒 Duration: 12-month contract (extension possible)
⏰ Hours: Monday–Friday | 8:00 AM–5:00 PM
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:
- Bachelor's degree
- Project management experience
- Experience writing policies/procedures
- Medicare/Medicaid and accreditation audit experience
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