Clinical Quality and Compliance Coordinator

Telligen•Oklahoma City, OK

About The Position

As the Clinical Quality and Compliance Coordinator you will be responsible for coordinating quality assurance (QA), quality improvement (QI), accreditation, regulatory compliance, and credentialing activities across clinical programs, including Utilization Management (UM), Case Management (CM), and Disease Management (DM). You will provide hands-on support for audit activities, quality improvement initiatives, accreditation readiness, state regulatory filings, credentialing processes, and staff education. You will assist with the development and execution of audit tools and education materials under direction and supports tracking, documentation, and monitoring activities to ensure compliance with URAC, NCQA, state regulatory, and contractual requirements.

Requirements

Registered Nurse (RN) or Licensed Practical Nurse (LPN) license
Minimum 2 years of experience in QA/QI, compliance, credentialing, or healthcare operations.
Working knowledge of URAC and/or NCQA standards.
Experience with clinical documentation review and audit processes.
Strong understanding of quality improvement methodologies (e.g., PDSA cycles).

Nice To Haves

Bachelorâs degree in Nursing, Healthcare Administration, Public Health, or related field.
Certification in healthcare quality or compliance (e.g., CPHQ, CPMSM).
Experience supporting accreditation surveys, credentialing audits, and state URO filings.

Responsibilities

Support quality assurance (QA) and quality improvement (QI) activities for assigned contracts and clinical programs
Track quality deliverables, performance measures, and improvement activities to ensure timely and accurate completion
Maintain documentation related to Plan-Do-Study-Act (PDSA) cycles and other quality improvement initiatives
Support corrective action plans (CAPs) through documentation, tracking, and follow-up activities
Assist with audit and monitoring activities, including clinical file reviews, documentation audits, and compliance checks
Execute audits using approved audit tools and methodologies
Assist with the development, maintenance, and refinement of audit tools, checklists, and templates under direction, including mapping to applicable accreditation and regulatory standards
Compile audit materials, document findings, and assist with trend analysis and issue tracking
Maintain audit logs, trackers, and evidence repositories to support remediation and reporting
Support accreditation readiness activities for URAC, NCQA, and other applicable accrediting bodies
Assist with the collection, organization, and submission of accreditation and regulatory evidence
Maintain accreditation trackers, compliance logs, and documentation repositories
Support preparation and maintenance of state Utilization Review Organization (URO) applications, renewals, and amendments under direction
Support credentialing and recredentialing activities for clinical staff and delegated entities
Assist with primary source verification (PSV) documentation collection and file organization
Maintain credentialing logs, trackers, and audit documentation
Support credentialing audits and corrective action activities as assigned
Assist with the development and updating of staff education materials related to quality, compliance, accreditation, and credentialing under direction
Draft training materials, job aids, and reference documents and update existing education based on policy or regulatory changes
Support delivery of onboarding and refresher education sessions as assigned
Track training completion and maintain required documentation
Support policy and procedure maintenance through formatting, version control, and document management
Prepare draft reports and summaries for leadership and committee review