Medical Management Accreditation & Audit Coordinator – Work From Home
About The Position
This position conducts audits and monitors ongoing quality improvement activities within the medical management program. It analyzes compliance with departmental policies and regulatory and accrediting requirements, and prepares reports for management presentation to internal ancillary departments and committees. The coordinator also serves as a resource to internal ancillary departments on quality and utilization issues and contributes to accreditation survey processes. This is a remote/work-from-home role that may be performed from anywhere in the continental United States except California, New York, Alaska, and Hawaii. Richardson, Texas, is preferred. Work hours are 8:00 a.m. to 5:00 p.m. CST, Monday through Friday. The role is to be filled by an independent worker with adequate direction and flexibility to accommodate changing responsibilities. Sponsorship is not available.
Requirements
- Unrestricted license to practice in the state of operations as a Registered Nurse (RN), Licensed Practical Nurse (LPN), or Behavioral Health Professional.
- Three years of clinical experience, including two years of 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 using Microsoft Office software.
Nice To Haves
- Bachelor’s degree in Nursing, Health Administration, or a healthcare field.
- Certified Professional in Healthcare Quality (CPHQ) certification.
- Audit, utilization management, and health plan experience.
Responsibilities
- Conduct audits within the medical management program.
- Monitor ongoing quality improvement activities within the medical management program.
- Analyze compliance with departmental policies and regulatory 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.
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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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
