Med Mgmt Accred & Audit Coord (Statewide)

Hcsc Clayton , NM 88415

Posted 4 months ago

Job ID: RMP-1033824 Description:

We are the Health Care Management division of HCSC a team of dedicated nurses, doctors and other clinicians. Everything we do, and every decision we make, aims to help our members live their most healthy lives. We treat the whole person with integrated pharmacy, physical and mental health care benefits.

We're also tackling the social determinants of health by creating non-clinical partnerships in the communities where we work and live, because everyone should have access to quality health care. We use innovative tools and approaches to help members get the most out of their plan benefits, as affordably as possible. We are more than a health care insurer and we are truly anchored in our purpose: to do everything in our power to stand by our members in sickness and in health.

Note: This is a work-from-home position.

BASIC FUNCTION (Behavioral Health):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.

JOB REQUIREMENTS:

  • Registered Nurse (RN), Licensed Practical Nurse (LPN), Licensed Independent Social Worker (LISW), Licensed Social Worker (LSW) or other 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 REQUIREMENTS:

  • Bachelor Degree in Nursing or Health Administration or in the healthcare field.

  • Certified Professional Health Care Quality (CPHQ Certification).

  • 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 Behavioral Health Job Type Full-Time Regular Location NM - Grants, NM - Ruidoso, NM - Las Vegas, NM - Tatum, NM - Santa Fe, NM - Artesia, NM - Silver City, NM - Truth or Consequences, NM - Lovington, NM - Raton, NM - Clayton, NM - Clovis, NM - Gallup, NM - Taos, NM - Fort Sumner, NM - Carlsbad, NM - Springer, NM - Deming, NM - Vaughn, NM - Hobbs, NM - Roswell, NM - Santa Rosa, NM - Socorro, NM - Los Alamos, NM - Portales, NM - Alamogordo, NM - Tucumcari, NM - Farmington, NM - Las Cruces, NM - Lordsburg, NM - Espanola, NM - Albuquerque, NM - Hagerman


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Med Mgmt Accred & Audit Coord (Statewide)

Hcsc