Provider Management Specialist 1 (Nurse Reviewer)

Location: Illinois (Remote with On‑Site Visits)

Position Overview

The Provider Management Specialist conducts provider compliance reviews, evaluates documentation, and performs on‑site visits to ensure adherence to state regulations. This role requires strong clinical experience, attention to detail, and excellent customer service while working both remotely and in the field.

Duties & Responsibilities

• Build and maintain positive relationships with users and providers to deliver high‑quality customer service.
• Evaluate providers for compliance with applicable regulations and program requirements.
• Coordinate and schedule on‑site provider visits and clearly communicate all visit requirements.
• Conduct informational provider compliance interviews.
• Assess provider documentation, business practices, and operational processes against established standards.
• Collect, organize, and submit data and documentation obtained from provider sites.
• Utilize technology to manage all review activities, including converting paper documentation to electronic format and uploading via web‑based applications.
• Conduct in‑person assessments of physical provider sites for compliance.
• Summarize on‑site visit findings in clear, accurate reports.
• Identify trends in non‑compliance or ineffective business practices.
• Make timely and appropriate recommendations 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 to diverse staff and providers.
• Active listening skills and effective communication techniques.
• Computer literacy, including MS Word, Excel, Outlook, and web‑based applications.
• Process‑oriented, results‑driven approach to work.
• Ability to foster teamwork with colleagues at all levels.
• Ability to work independently and within a team environment.
• Excellent customer service and professional communication (verbal and written).
• High accuracy, strong attention to detail, and commitment to quality.
• Ability to meet deadlines and adhere to strict standards.
• Ability to travel to provider sites throughout the state of Illinois.

Qualifications

Education

• Bachelor’s degree in any field (Nursing preferred)

Experience

• 2+ years of clinical experience working with:
  • Critical care providers
  • Public health providers
  • Providers serving children, older adults, individuals with traumatic brain injury, or individuals with developmental disabilities
• 1+ year of experience performing quality assurance reviews.

Certification

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

Working Conditions

• Remote work and on‑site visits (2 to 3 per week) at provider facilities across Illinois.

Benefits Through SSO

SSO offers a comprehensive benefits package supporting your well‑being, financial stability, and long‑term growth, including:

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

Keyword Search Terms 

Nurse Reviewer, Provider Management Specialist, RN Reviewer, Compliance Nurse, Provider Compliance, Healthcare Quality Review, Medicaid Compliance, Clinical Reviewer, Illinois RN, Site Visit Nurse, Healthcare Auditor, Public Health Nursing, QA Nurse, Provider Monitoring.