Medical Management Accreditation & Audit Coordinator
New
H
HCSCHealthcare quality
This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii, Work Hours are 8 AM to 5 PM CST, Monday through Friday.Full-TimeMiddle
Salary$69,800.00 - $125,900.00
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Job Details
- Experience
- 3 years clinical experience, including 2 years utilization review or case management experience
- Required Skills
- Microsoft Office
Requirements
- Hold an unrestricted RN, LPN, or behavioral health professional license to practice in the state of operations.
- Have 3 years of clinical experience, including 2 years of utilization review or case management experience.
- Have quality improvement experience.
- Have working knowledge of the Medical Management Program and UM/CM policies and practices.
- Have analytical skills.
- Have verbal and written communication skills.
- Have PC experience using Microsoft Office software.
- A bachelor's degree in nursing, health administration, or a healthcare field is preferred.
- CPHQ certification is preferred.
- Audit, utilization management, and health plan experience are preferred.
- Work 8 AM to 5 PM CST, Monday through Friday.
Responsibilities
- Conduct audits within the medical management program.
- Monitor ongoing quality improvement activities.
- Analyze compliance with departmental policies and 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.
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