Medical Management Accreditation, Audit Coordinator

🔥 0 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $69.8k - $125.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Health Care Service Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Health Care Service Corporation is an independent licensee of the Blue Cross Blue Shield Association, serving nearly 23 million people across the United States with a wide range of health benefit solutions. The company provides health coverage options for various groups, including employers, individuals, families, as well as Medicare and Medicaid plans. In addition to health insurance, HCSC offers services such as pharmacy solutions, life and dental insurance, and health data technology. With nearly a century of experience, HCSC is dedicated to improving access to quality care, enhancing health outcomes, and reducing costs while maintaining a deep commitment to its members and local communities.

📋 Description

• Conduct audits and monitor ongoing quality improvement activities within the medical management program • Analyze compliance with departmental policies, regulatory requirements, 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 • Accommodate changing responsibilities as an independent worker

🎯 Requirements

• 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 • Sponsorship is not available • 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 (preferred)

🏖️ 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 • Annual incentive bonus plan

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