Job ID: WS-1038053
This position is responsible for ensuring the care coordination clinical records reflect accurate and timely documentation to meet compliance mandates. This position will identify areas of opportunity to improve documentation and audit outcomes. This position impacts the integrity of the Medical Management Program. In addition, this position significantly contributes toward the achievement to maintain accreditation with national accreditation agencies.
Registered Nurse (RN) with current, active, unrestricted RN license in the state of operations (or reciprocity). For compact licensee changing permanent residence to state of operations, you must obtain active, unrestricted RN licensure in the state of operations within 90 days of hire.
3 years of clinical nursing experience.
2 years of managed care insurance medical review experience.
Knowledge of medical terminology and procedures.
Verbal and written communication skills to respond to internal and external inquiries, compose policies and communicate policy changes, and facilitate training.
Knowledge of HEDIS measures
Must be proficient with Excel (sorting through templates, data fields and an overall strong knowledge of basic Excel functionality)
Proven to be adept at navigating new systems and tech with little impact to your daily agenda.
Experience with Coding is highly preferred
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 Quality Assurance Job Type Full-Time Regular Location TX - Richardson, IL - Chicago, IL - Naperville