Clinical Audit Coordinator | Hybrid | Chicago, IL | Contract

Back Clinical Audit Coordinator | Hybrid | Chicago, IL | Contract Clinical Audit Coordinator | 3 years’ experience | Hybrid | Contract Walker Healthforce is seeking a Clinical Audit Coordinator with 3 years’ experience to support a healthcare client. This is a 12‑month contract to hire opportunity. Start Date: ASAP Hours/Schedule: Monday‑Friday, 40 hours Worker Type: W2 Core Requirements 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 interpreting and implementing 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) Additional Requirements Must reside in Chicago, IL Bonus Requirements 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. Job Responsibilities Provides ongoing monitoring and education to Subcontractors staff related to Clinical and behavioral health requirements, performs Clinical and Mental Health onsite audits, including scheduling and educating the subcontractors on purpose and process of oversight, oversees clinical processes for participating and prospective subcontractors related to medical and behavioral health Participate in development, implementation and management of process and system to monitor and evaluate Enterprise delegated activities to subcontractors, Medical groups, IPAs and vendors for Commercial, Exchange, Medicare and Medicaid products. Provide input and perform maintenance of Enterprise pre‑delegated and delegated oversight documentation (policies, procedures, audit tools, guidelines, reporting formats, communication materials and scheduling) consistent with the intent of regulatory/accreditation requirements for the enterprise. Schedule and perform timely pre‑delegation assessments (documentation and onsite) of proposed delegated groups according to established Enterprise policies to determine delegates’ compliance with regulatory/accreditation standards, ability to perform proposed delegated functions and ability to meet quality and service goals. Prepare timely pre‑delegation assessment report, summary and recommendation and disseminate to management, internal areas and committees for analysis to the appropriate areas. Schedule and perform annual and periodic audits (documentation and onsite) of delegated groups according to established Enterprise policies to ensure continued compliance with regulatory/accreditation requirements and standards while staying within budget requirements. Make initial decision and recommendation if subcontractors processes and operations are compliant with multiple Health Plans, State and federal regulatory requirements and accreditation standards including staffing, policy and procedures, infrastructure, Certificate/Licensures, insurance, system and facilities. Verify receipt of delegate reporting and perform necessary follow‑up to ensure receipt of reporting. Monitor and review reporting to ensure accuracy, summarize compliance with established goals and disseminate to management, internal areas and committee for analysis, identification of areas for improvement, action plans and follow‑up. What We Offer Competitive compensation package Weekly pay via Direct Deposit Medical, Dental & Vision available 401(k) options We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability status or protected veteran status. #J-18808-Ljbffr Walker Healthforce, LLC