Medical Management Accreditation & Audit Coordinator – Work From Home

Health Care Service Corp.; United States; Remote; USD 70,000 - 126,000; Full time

Job summary

Health Care Service Corporation conducts audits and monitors quality improvement within the medical management program, analyzing compliance with policies, regulatory and accrediting requirements, and preparing management reports for internal departments and committees.

The role serves as a resource on quality and utilization issues and supports accreditation survey processes, with standard work hours and remote flexibility across the continental United States.

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

Responsibilities

• Audit and monitor quality improvement activities within the medical management program
• Analyze compliance with departmental policies, regulatory and accrediting requirements
• Prepare reports for management presentation to internal ancillary departments and committees
• Serve as a resource to internal ancillary departments on quality and utilization issues
• Contribute to accreditation survey processes

Skills

Clinical experience

Utilization review

Quality improvement

Analytical skills

Verbal and written communication

Microsoft Office

Education

Bachelor Degree in Nursing or Health Administration

CPHQ Certification

Job description

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.

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.

#LI-FW1 #LI-Remote This is a Remote/Work-From-Home role. Richardson, TX preferred. Sponsorship is not available

Pay Transparency Statement:

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. https://careers.hcsc.com/totalrewards

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 - $125,900.00 Exact compensation may vary based on skills, experience, and location.

For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren't afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you'll have to improve health care delivery in an open, collaborative environment.

HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants.

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations.

Please note that only requests for accommodations in the application process will be returned.

Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas, Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association Copyright 2025 Health Care Service Corporation. All Rights Reserved.