Medical Management Accreditation & Audit Coordinator – Work From Home

Workday, Inc. (old); United States; Remote; USD 70,000 - 126,000; Full time

Job summary

Health Care Service Corporation is seeking a qualified professional to audit and improve quality within the medical management program. You will analyze compliance with policies and regulatory standards and prepare management reports.

This role serves as a resource for internal departments on quality and utilization issues and supports accreditation activities. The ideal candidate has a nursing license or equivalent, at least 3 years of clinical experience with utilization review, and strong

Qualifications

• RN or LPN or Behavioral Health Professional with unrestricted license in state of operations.
• 3 years clinical experience, incl. 2 years utilization review/case management.
• Quality improvement experience.
• Work hours 8 AM–5 PM CST, Monday–Friday.

Responsibilities

• Audit and monitor quality improvement activities in the medical management program.
• Analyze compliance with policies, regulatory and accrediting requirements.
• Prepare reports for management and support internal departments on quality/utilization.

Skills

Analytical skills

Verbal communication

Written communication

PC proficiency

Education

Bachelor's degree in Nursing or Health Administration or healthcare field

Tools

Microsoft Office

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.

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 - $125,900.00

Exact compensation may vary based on skills, experience, and location.