Remote Medical Management Audit & QA Coordinator

Health Care Service Corp.; United States; Remote; USD 70.000 - 126.000; Vollzeit

Zusammenfassung

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.

Qualifikationen

• 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

Aufgaben

• 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

Kenntnisse

Clinical experience

Utilization review

Quality improvement

Analytical skills

Verbal and written communication

Microsoft Office

Ausbildung

Bachelor Degree in Nursing or Health Administration

CPHQ Certification

Jobbeschreibung

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.