Job Description
- Coordinates, conducts, and documents delegation assessments as necessary to comply with state, federal, NCQA, and any other applicable requirements.
- Develops format and documents periodic status reports from Delegated Entities.
- Develops corrective action plans when deficiencies are identified, and documents follow-up to completion.
- Ensures delegated entity’s compliance with reporting requirements by tracking the receipt and completeness of reports.
- Develops corrective action plans when compliance issues are identified, and document follow-up to completion
Qualifications
- Must be RN or LVN
- Bachelor’s degree in related field or equivalent experience
- Familiarity with physician referrals, medical decision-making, working in a clinical environment, compliance practices
- 1+ years clinical experience as RN
- 8-10 years managed care experience
- Extensive knowledge of MS Word/Excel/Access
- Knowledge of NCQA and HEDIS standards and applicable state and federal laws
Additional Information
Hours: Monday-Friday 8:00am to 5:00pm, no OT, nights, no weekend or travel
Pay rate: $30-$37/hr
Interested in being considered?
If you are interested in applying to this position, please contact Jeff St Louis at 407-478-0332x223 and click the Green I’m Interested Button to email your resume.
Company Description
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!