At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.

Come join us and be part of a purpose driven company who is  invested in your future!

Job Summary

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).

**This is a Flex position (in the office 3 days a week), the office locations are: Chicago, IL-HQ office, Richardson, TX-HQ office or Tulsa, OK-HQ office**

Required Job Qualifications:

• Registered Nurse (RN), unrestricted license to practice in state.

• 6 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.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

HCSC Employment Statement:

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.