Duration: November 2025 to June 2026 (possible extension)
Pay: $41.00 / hr on W2
# of Openings: 4
Position
Clinical Delegation Coordinator
Basic Function
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.
Essential Functions
1. Reviews and evaluates UM / QR plans for prospective and existing Medical Groups / IPAs in the HMO networks. Prepares reports on findings and communicates outcomes to Medical Groups / IPAs and HMO management.
2. Communicates contractual requirements to medical groups, IPAs, and contract management firms, corporate headquarters including but not limited to utilization management, quality review, clinical, and non-clinical quality improvement.
3. Monitors UM activities of Medical Groups / IPAs to measure adherence to HMO UM / QR standards by conducting annual UM / QR audits. Evaluates results, prepares reports on findings, and communicates outcomes to Medical Groups / IPAs and HMO management.
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 driver’s license.
Able and willing to travel, including overnight stays.