Med Mgmt Accred & Audit Coord

At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career. Come join us and be part of a purpose driven company who is invested in your future! 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. Responsibilities *Conduct audits as well as monitoring ongoing quality improvement activities within the Medical Management Program. *Analyze compliance with departmental policies, regulatory and accrediting requirements. *Prepare reports for management presentation to internal ancillary departments and committees. *Serve as resource to internal ancillary departments on quality and utilization issues. *Contribute to Accreditation Survey processes. #LI-HYBRID 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) We encourage people of all backgrounds and experiences to apply. Even if you don’t meet every listed qualification, apply anyway - you might have qualifications we haven’t even thought of yet. Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! HCSC Employment Statement: HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Join our talent community and receive the latest HCSC news, content, and be first in line for new job opportunities. Join our Talent Community. For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren’t afraid to make innovative contributions. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you’ll have to improve health care delivery in an open, collaborative environment. HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations. Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions. 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