Nurse Reviewer

Duties & Responsibilities

• Build and maintain effective relationships with providers and users to support high-quality customer service.
• Evaluate providers for compliance with applicable state and program regulations.
• Cook up and schedule on-site provider visits; clearly communicate visit requirements.
• Conduct compliance interviews with providers and gather all necessary information.
• Review provider documentation, policies, and business practices for regulatory alignment.
• Collect, organize, and submit documentation supporting compliance findings.
• Utilize technology and web-based systems to convert paper documentation to electronic format.
• Conduct in-person assessments of provider sites to evaluate compliance with oversight requirements.
• Summarize on-site visit findings accurately and professionally.
• Exercise independent judgment to evaluate compliance and make final determinations based on documented evidence.
• Identify deficiencies and recommend appropriate next steps to support provider improvement.
• Analyze trends in non-compliance and identify gaps in provider business processes.
• Provide timely recommendations and updates 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 well to staff and providers.
• Active listening and effective communication skills.
• Proficiency in MS Word, Excel, Outlook, and web-based applications.
• Process-oriented and results-driven work approach.
• Ability to foster teamwork and collaborate across levels of management and staff.
• Ability to work independently and within a team environment.
• Excellent written and verbal communication skills and customer-service techniques.
• High accuracy, strong attention to detail, and commitment to quality.
• Prioritize meeting deadlines and follow strict standards.
• Ability to travel regularly to provider sites across Illinois.

Qualifications

• Education: Bachelor’s degree in any field (Nursing preferred).
• Experience: Minimum 2 years of clinical experience working with critical care providers, public health providers, or providers serving children, older adults, individuals with traumatic brain injury, or individuals with developmental disabilities.
• Experience: Minimum 1 year of experience conducting quality assurance reviews.
• Certification: Active Illinois Registered Professional Nurse (RN) license required.

Working Conditions

• Remote work with 2–3 on-site provider visits per week throughout the state of Illinois.

Benefits

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