Clinical Delegation Coord
About The Position
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. Job Summary This position is responsible for leading, coordinating and participating in clinical delegation oversight audits of HCSC’s vendors, service providers, medical groups and/or delegated subcontracted providers reviewing adherence to regulatory and contractual requirements. The position also develops audit tools based on state and federal regulations, conducts the reviews in accordance with accreditation standards and clinical guidelines . Creates reports regarding audits, and analyzes, tracks and trends audit findings. Develops and monitors corrective actions and provides feedback to practitioners on performance. May support in drafting amendments to agreements.
Requirements
- Registered Nurse (RN), unrestricted license to practice in state.
- 3 years managed care experience or health plan operations experience
- Experience developing and analyzing reports.
- Experience in performing delegation oversight and monitoring multiple delegated functions, state and products.
- Experience interpreting and implementing accreditation standards (NCQA and URAC).
- Experience to interpret and implement state and federal health insurance regulations.
- Organizational skills.
- Verbal and written communications skills to include delivering presentations to committees and acting as company representative to subcontractor management (Vendors and Delegates).
- PC experience to include Microsoft Office suite of applications (Word, Excel).
Nice To Haves
- Bachelor degree in Nursing, Health Care Administration or health care field.
- Experience in auditing accreditation standards and state and federal regulations.
- Medicaid or Medicare experience.
- Presentation application experience (such as PowerPoint) and database experience.
- Project management experience including leading projects.
- Experience in creating and writing processes, policy and procedures.
Responsibilities
- leading, coordinating and participating in clinical delegation oversight audits of HCSC’s vendors, service providers, medical groups and/or delegated subcontracted providers reviewing adherence to regulatory and contractual requirements
- develops audit tools based on state and federal regulations
- conducts the reviews in accordance with accreditation standards and clinical guidelines
- Creates reports regarding audits, and analyzes, tracks and trends audit findings
- Develops and monitors corrective actions and provides feedback to practitioners on performance
- May support in drafting amendments to agreements
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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
