Medical Management Accreditation and Audit Coordinator (RICHARDSON, TX - TELECOMMUTER)-

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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.

**Needed experience and skills**:
*Knowledge of NCQA and HEDIS standards - a MUST.
*A SME (Subject Matter Expert) for NCQA, Regulatory Oversight and Policy and Procedure.
*Project Delivery/Coordination experience.
*Experience in conducting Audit of Complex Case Management/Utilization Management cases.
*Ability to travel (25%) – including overnight stays

*Knowledge of Computer Skills (Microsoft Office Suites).
*Presentation and Analytical skills.
 

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)

The Compensation/Salary offered for this Position will vary depending on Job-related skills, education, knowledge and experience. This role aligns with an Annual Performance Incentive (Bonus) plan.

#LI-Remote
 

Relocation assistance will not be provided for this position.

Sponsorship will not be provided for this position.

We encourage people of all backgrounds and experiences to apply.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

HCSC Employment Statement:

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, 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.

Base Pay Range$58,800.00 - $130,100.00