Medical Management Accreditation, Audit Coordinator

This is a fully remote position, open to applicants in Texas.

📋 Description

• Perform audits and oversee ongoing quality enhancement initiatives within the medical management program.

• Evaluate adherence to departmental policies, regulatory standards, and accreditation requirements.

• Create reports for management to present to internal ancillary departments and committees.

• Act as a resource for internal ancillary departments regarding quality and utilization matters.

• Participate in accreditation survey processes.

• Adapt to evolving responsibilities as an independent worker.

⛳️ Requirements

• Registered Nurse (RN), Licensed Practical Nurse (LPN), or Behavioral Health Professional with an unrestricted license to practice in the state of operation.

• Minimum of 3 years of clinical experience, including at least 2 years in utilization review or case management.

• Experience in quality improvement.

• Familiarity with the Medical Management Program and UM/CM policies and procedures.

• Strong analytical skills.

• Excellent verbal and written communication abilities.

• Proficient in using Microsoft Office software on a PC.

• Sponsorship is not available.

• Bachelor’s degree in Nursing, Health Administration, or a related healthcare field (preferred).

• Certified Professional Health Care Quality (CPHQ Certification) (preferred).

• Experience in auditing, utilization management, and health plans (preferred).

🏝️ 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.