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Clinical Quality and Compliance Coordinator en Telligen

Telligen · West Des Moines, Estados Unidos De América · On-site

Microsoft Excel

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Description

As the Clinical Quality and Compliance Coordinator you will be responsible for coordinating quality assurance (QA), quality improvement (QI), accreditation, regulatory compliance, and credentialing activities across clinical programs, including Utilization Management (UM), Case Management (CM), and Disease Management (DM). You will provide hands-on support for audit activities, quality improvement initiatives, accreditation readiness, state regulatory filings, credentialing processes, and staff education. You will assist with the development and execution of audit tools and education materials under direction and supports tracking, documentation, and monitoring activities to ensure compliance with URAC, NCQA, state regulatory, and contractual requirements. 

Essential Functions

  • Support quality assurance (QA) and quality improvement (QI) activities for assigned contracts and clinical programs
  • Track quality deliverables, performance measures, and improvement activities to ensure timely and accurate completion
  • Maintain documentation related to Plan-Do-Study-Act (PDSA) cycles and other quality improvement initiatives
  • Support corrective action plans (CAPs) through documentation, tracking, and follow-up activities

  • Assist with audit and monitoring activities, including clinical file reviews, documentation audits, and compliance checks
  • Execute audits using approved audit tools and methodologies
  • Assist with the development, maintenance, and refinement of audit tools, checklists, and templates under direction, including mapping to applicable accreditation and regulatory standards
  • Compile audit materials, document findings, and assist with trend analysis and issue tracking
  • Maintain audit logs, trackers, and evidence repositories to support remediation and reporting

  • Support accreditation readiness activities for URAC, NCQA, and other applicable accrediting bodies
  • Assist with the collection, organization, and submission of accreditation and regulatory evidence
  • Maintain accreditation trackers, compliance logs, and documentation repositories
  • Support preparation and maintenance of state Utilization Review Organization (URO) applications, renewals, and amendments under direction

  • Support credentialing and recredentialing activities for clinical staff and delegated entities
  • Assist with primary source verification (PSV) documentation collection and file organization
  • Maintain credentialing logs, trackers, and audit documentation
  • Support credentialing audits and corrective action activities as assigned

  • Assist with the development and updating of staff education materials related to quality, compliance, accreditation, and credentialing under direction
  • Draft training materials, job aids, and reference documents and update existing education based on policy or regulatory changes
  • Support delivery of onboarding and refresher education sessions as assigned
  • Track training completion and maintain required documentation
  • Support policy and procedure maintenance through formatting, version control, and document management
  • Prepare draft reports and summaries for leadership and committee review

    • Requirements

  • Registered Nurse (RN) or Licensed Practical Nurse (LPN) license
  • Minimum 2 years of experience in QA/QI, compliance, credentialing, or healthcare operations.
  • Working knowledge of URAC and/or NCQA standards.
  • Experience with clinical documentation review and audit processes.
  • Strong understanding of quality improvement methodologies (e.g., PDSA cycles).

  • Preferred:
  • Bachelor’s degree in Nursing, Healthcare Administration, Public Health, or related field.
  • Certification in healthcare quality or compliance (e.g., CPHQ, CPMSM).
  • Experience supporting accreditation surveys, credentialing audits, and state URO filings.

    • Additional Information

    Who We Are:
     
    Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise.

    Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions.

    Our business is our people and we’re seeking talented individuals who share our passion and are ready to take ownership, make an impact and help shape the future of health.

    Are you Ready?
     
    We’re on a mission to transform lives and economies by improving health.
     
    Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success.
    Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are.
    Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives.
    Integrity: We foster a respectful, inclusive, and collaborative environment built on trust and excellence.
      
    Thank you for your interest in Telligen!
    Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed.

    While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate.
    Telligen and our affiliates are Equal Opportunity Employers and E-Verify Participants.
    Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. We will not accept 3rd party solicitations from outside staffing firms.
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