[Hiring] Medical Management Accreditation & Audit Coordinator @Health Care Service Corporation

Role Description

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.

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

Requirements

• Bachelor Degree in Nursing or Health Administration or in the healthcare field (preferred)
• Certified Professional Health Care Quality (CPHQ Certification) (preferred)
• Audit, Utilization Management and Health Plan experience needed (preferred)
• Independent worker with adequate directions provided and flexible to accommodate changing responsibilities
• Work Hours are 8 AM to 5 PM CST, Monday through Friday

Benefits

• 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
• Other incentives

Company 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.