Nurse Liaison I - Utilization Management & Quality Review - Remote

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary This position is responsible for ensuring compliance with Utilization Management (UM) and Quality Review (QR) functions performed by the health plan. The role supports clinical review activities requiring 5+ years of experience as a Nurse Reviewer or Clinical Reviewer. Responsibilities include assisting with benefit determinations, medical necessity reviews, benefit terminations, and process improvements while ensuring clinically sound and well-documented coverage decisions and compliance. Required Job Qualifications Registered Nurse (RN) with an 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. Preferred Job Requirements 5+ years of Medicare Review and Medicare Advantage Health Plan experience. 4+ years of experience as a Nurse Reviewer, Clinical Reviewer, or similar clinical review role. Strong prior authorization experience within a