Remote Medical Management Quality & Audit Coordinator

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

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