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.

This position is responsible for leading, coordinating and participating in clinical delegation oversight audits of HCSC’s vendors, service providers, medical groups and/or delegated subcontracted providers reviewing adherence to regulatory and contractual requirements. The position also develops audit tools based on state and federal regulations, conducts the reviews in accordance with accreditation standards and clinical guidelines. Creates reports regarding audits, and analyzes, tracks and trends audit findings. Develops and monitors corrective actions and provides feedback to practitioners on performance. May support in drafting amendments to agreements. Able and willing to travel, including overnight stays (approximately 30 overnight travel).

Required Job Qualifications:

• Registered Nurse (RN), unrestricted license to practice in state.
• 3 years managed care experience or health plan operations experience.
• Experience developing and analyzing reports.
• Experience in performing delegation oversight and monitoring multiple delegated functions, state and products.
• Experience interpreting and implementing accreditation standards (NCQA and URAC).
• Experience to interpret and implement state and federal health insurance regulations.
• Organizational skills.
• Verbal and written communications skills to include delivering presentations to committees and acting as company representative to subcontractor management (Vendors and Delegates).
• PC experience to include Microsoft Office suite of applications (Word, Excel).
• Able and willing to travel, including overnight stays (approximately 30 overnight travel).
  
  

Preferred Job Qualifications:

• Bachelor degree in Nursing, Health Care Administration or health care field.
• Experience in auditing accreditation standards and state and federal regulations.
• Medicaid or Medicare experience.
• Presentation application experience (such as PowerPoint) and database experience.
• Project management experience including leading projects.
• Experience in creating and writing processes, policy and procedures.

HCSC Employment Statement:

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, 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.