Medical Management Accreditation & Audit Coordinator – Work From Home

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.

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)
• Audit, Utilization Management and Health Plan experience needed.
• Due to business needs, this Position is to be filled with an independent worker with adequate directions provided and flexible to accommodate changing responsibilities.
• Work Hours are 8 AM to 5 PM CST, Monday through Friday.

This is a Remote/Work-From-Home role. Richardson, TX preferred.

Sponsorship is not available

This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.

Base Pay Range

$69,800.00 - $125,900.00