Medical Management Accreditation & Audit Coordinator – Work From Home
Required skills
- Registered Nurse
- RN
- Licensed Practical Nurse
- LPN
- Behavioral Health Professional
- unrestricted license
- clinical experience
- utilization review
- case management
- quality improvement
Nice to have
- Nursing
- Health Administration
- Audit
- Utilization Management
- Health Plan experience
- independent worker
Role summary
HCSC is seeking a Medical Management Accreditation & Audit Coordinator to join their team. This remote role involves conducting audits, monitoring quality improvement activities within the medical management program, and analyzing compliance with policies and regulations. The coordinator will prepare reports for management, serve as a resource on quality and utilization issues, and contribute to accreditation survey processes. Requires a licensed RN, LPN, or Behavioral Health Professional with 3 years of clinical experience, including 2 years in utilization review or case management, and quality improvement experience. Proficiency in Microsoft Office and strong analytical and communication skills are essential. Preferred qualifications include a Bachelor's degree, CPHQ certification, and health plan experience.
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 conducting audits as well as monitoring ongoing quality improvement activities within the medical management program; analyzing compliance with departmental policies, regulatory and accrediting requirements, and preparing reports for management presentation to internal ancillary departments and committees; and serving as a resource to internal ancillary departments on quality and utilization issues and contributing to accreditation survey processes.REQUIRED JOB QUALIFICATIONS:*Registered Nurse (RN), Licensed Practical Nurse (LPN), OR Behavioral Health Professional with unrestricted license to practice in state of operations*3 years clinical experience, including 2 years utilization review or case management experience
*Quality improvement experience
- Working knowledge of the Medical Management Program and UM/CM policies and practices*Analytical skills*Verbal and written communication skills*PC experience utilizing Microsoft Office software
PREFERRED JOB QUALIFICATIONS:*Bachelor Degree in Nursing or Health Administration or in the healthcare field*Certified Professional Health Care Quality (CPHQ Certification)*Audit, Utilization Management and Health Plan experience needed.*Due to business needs, this Position is to be filled with an independent worker with adequate directions provided and flexible to accommodate changing responsibilities.*Work Hours are 8 AM to 5 PM CST, Monday through Friday.
This is a Remote/Work-From-Home role. Richardson, TX preferred.
Sponsorship is not available
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
Pay Transparency Statement:
At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting .
The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.
HCSC Employment Statement:
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.
Base Pay Range
$69,800.00 - $125,900.00Exact compensation may vary based on skills, experience, and location.
Originally posted on Himalayas
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