Clinical Delegation Coordinator-RN

JOB PURPOSE:

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.

Required Job Qualifications:

•Registered Nurse (RN), unrestricted license to practice in the state of Texas.
•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 proficiency to include Microsoft Office suite of applications (Word, Excel).
•Able and willing to travel, including overnight stays (approximately 30% overnight travel).

Preferred Job Qualifications:

•Experience in auditing accreditation standards and state and federal regulations.
•3 years clinical operations experience.
•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..

•CA

•CB

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.
Requirements: Expertise Nursing Job Type Full-Time Regular Location TX - Richardson


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