Clinical Delegation Coord II, IL

R0048158 At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development.

 

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.

      Required Job Qualifications:
  • Registered Nurse (RN), unrestricted license to practice in state.
  • 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 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.
  Telecommute: This is a Telecommute (Remote) role: Must reside within 250 miles of the office or anywhere within the posted state.   #LI-TELECOMMUTE #LI-SG1  

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

  Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From 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, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting   The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.    

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

 

Base Pay Range

$61,500.00 - $136,100.00  Exact compensation may vary based on skills, experience, and location.
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