At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.

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Job Summary

**THIS IS A TELECOMMUTER POSITION FOR THE RICHARDSON OFFICE**

This position is responsible for ensuring compliance of the Utilization Management (UM) and Quality Review (QR) functions performed by the Medical Groups/IPAs participating in the networks of BCBSIL’s HMOs. Evaluates the need for, designs, and implements educational seminars for medical groups/IPA staff, assists in benefit determinations, and provides support on transplant requests, benefit terminations and Individual Benefit Management Program (IBMP) cases. Able and willing to travel, including overnight stays.

JOB REQUIREMENTS:

• Registered Nurse (RN) with unrestricted license.
• 3 years clinical experience with 2 years experience in utilization review, quality assurance, or statistical research.
• Clinical knowledge, knowledge of the UM/QR process, and knowledge of managed care principles.
• Analytical, verbal and written communications skills.
• Current Illinois drivers license.
• Able and willing to travel, including.

#LI-Remote

Relocation assistance will not be provided for this position.

Sponsorship will not be provided for this position.

We encourage people of all backgrounds and experiences to apply. 

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

HCSC Employment Statement:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.