Offer summary

Qualifications:

Registered Nurse (RN), Licensed Practical Nurse (LPN), or Behavioral Health Professional with an unrestricted license in the state of operation., Minimum of 3 years of clinical experience, including 2 years in utilization review or case management., Experience in quality improvement processes., Working knowledge of Medical Management Programs and UM/CM policies..

Key responsibilities:

Conduct audits and monitor ongoing quality improvement activities within the Medical Management Program.

Analyze compliance with departmental policies, regulations, and accreditation standards, and prepare reports for management.

Serve as a resource on quality and utilization issues to internal departments.

Contribute to accreditation survey processes.

Job description

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 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; Serving as a resource to internal ancillary departments on quality and utilization issues and contributing to accreditation survey processes.

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)

This is a Telecommute (Remote) role: Must reside withing 250 miles of the office or anywhere within the posted state.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From 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, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.