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Health Care Service Corporation

Medical Management Accreditation, Audit Coordinator

Health Care Service Corporation

. Conduct audits and monitor ongoing quality improvement activities within the medical management program .

Posted 11/9/2026full-timeRemote • Texas • United StatesMid-LevelSenior💰 $69,800 - $125,900 per yearWebsite

Core Competencies

Role fit
Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in conducting audits and quality improvement activities within medical management programs, with strong analytical and communication skills to prepare reports and serve as a resource for internal departments. Holds a relevant nursing or healthcare degree and possesses experience in utilization review and case management.

Highest-signal resume keywords
Registered Nurse (RN)Utilization Review ExperienceQuality Improvement ExperienceCertified Professional Health Care Quality (CPHQ Certification)Analytical Skills

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills
Clinical ExperienceUtilization Management PoliciesCase Management ExperienceAudit ExperienceQuality Improvement Activities
Soft Skills
Verbal Communication SkillsWritten Communication SkillsIndependent Worker
Tools & Technologies
Microsoft Office Software
Certifications & Qualifications
Certified Professional Health Care Quality (CPHQ Certification)
Industry Keywords
Medical Management ProgramRegulatory RequirementsAccrediting RequirementsHealth Plan Experience

About the role

Key responsibilities & impact
  • Conduct audits and monitor ongoing quality improvement activities within the medical management program
  • Analyze compliance with departmental policies, regulatory requirements, and accrediting requirements
  • Prepare reports for management presentation to internal ancillary departments and committees
  • Serve as a resource to internal ancillary departments on quality and utilization issues
  • Contribute to accreditation survey processes
  • Accommodate changing responsibilities as an independent worker

Requirements

What you’ll need
  • Registered Nurse (RN), Licensed Practical Nurse (LPN), OR 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
  • Sponsorship is not available
  • Bachelor Degree in Nursing or Health Administration or in the healthcare field (preferred)
  • Certified Professional Health Care Quality (CPHQ Certification) (preferred)
  • Audit, Utilization Management and Health Plan experience (preferred)

Benefits

Comp & perks
  • Health and wellness benefits
  • 401(k) savings plan
  • Pension plan
  • Paid time off
  • Paid parental leave
  • Disability insurance
  • Supplemental life insurance
  • Employee assistance program
  • Paid holidays
  • Tuition reimbursement
  • Other incentives
  • Annual incentive bonus plan