Job ID: WS-1036053
This position is responsible for projects and development of documentation of standards to meet external accreditation requirements (NCQA, URAC, etc.), coordinating the development of documentation with internal areas at the Enterprise and Plan levels of the company and with internal stakeholders and external accreditation organizations. Responsible for the development, monitoring and maintenance of Enterprise policies, procedures, metrics and evaluation tools. Review procedures and recommend improvements. Act as subject matter expert, handle complex assignment, and may assist with training/mentoring department staff
Required Job Qualifications:
- Bachelor degree and 2 years managed care experience involving independent judgment OR 6 years managed care experience involving independent judgment.
- 2 years managed care accreditation policy review experience including creating, developing, and maintaining policies and procedures.
- Experience with Total Quality Management (TQM)/Continuous Quality Improvement (CQI) concepts.
- Knowledge of accreditation and regulatory policies and standards (i.e., URAC, NCQA, DOI).
- Verbal and written communications skills including training skills.
- Knowledge of health care industry terminology and processes. PC experience to include Microsoft Office.
- Experience handling multiple priorities while functioning collaboratively within a team to achieve organizational goals and objectives
Preferred Job Qualifications:
- Strong knowledge of Sharepoint
- Detailed oriented
- Experience in Claims/Billing
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Expertise Regulatory & Compliance Job Type Full-Time Regular Location IL - Downers Grove, TX - Dallas, OK - Tulsa, MT - Helena, TX - Richardson, IL - Chicago, NM - Albuquerque