Overnight Utilization Management Jobs (NOW HIRING)

MISSION

Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.

VALUES

HealthOne is guided by a cultural framework that embodies our values and drives our decisions.

Our PURPOSE is to care for people by connecting them to resources that help protect them in health related situations. To fulfill our purpose, we align our PRIORITIES to ensure each decision we make is ethical, empathetic, economical, and efficient. We care for PEOPLE by being welcoming, authentic, truthful, consistent, and humble. We are continuously looking for ways to improve our PROCESS and how we get things done.

HealthOne seeks individuals with integrity and heart to embody our values. Whether you're starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.

JOB PURPOSE

The Regulatory Compliance Project Specialist is responsible for compiling, reviewing, and submitting documentation to support and respond to audits and reviews initiated by both state and federal regulators. This position oversees, monitors, and assists with quality assurance and related compliance functions to ensure timely response to annual regulatory data submissions as well as Market Conduct Examinations and CMS Compliance Reviews. Reporting to the Director of Quality Assurance and Privacy Officer, this position may be responsible to provide administrative, analytical, and technical support for the Quality Assurance Department.

ESSENTIAL JOB DUTIES

Maintain a working knowledge of federal and state regulations, reporting deadlines, and documentation requirements

Collaborate with Director to review and develop a project plan for managing and responding to a regulatory audit or review

Proficient in navigation and information mining from systems used in company operations such as; claims processing, enrollment and billing, utilization management, and call center operation.

Compile, review, and submit accurate and timely documentation in response to regulatory audit requests

Develop and monitor corrective action plans as may be required

Assist in establishing, updating, and communicating new and existing compliance policies and procedures for internal departments based on regulatory audit results

Monitor, plan and compile documentation for annual regulatory filings assigned by the Director

Provide administrative, analytical, and technical support for the Quality Assurance Department as needed in relation to regulatory compliance

Maintains regular and predictable attendance

Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice

Works to encourage and promote Company culture throughout the organization

Other duties as may be assigned

QUALIFICATIONS

Associate degree or equivalent

Three to five years' healthcare or health insurance experience

Working knowledge of federal and state regulations for the insurance industry

Working knowledge of claim and utilization management processes

Preferred experience in health insurance or related field

Competency with Microsoft Word and Excel as well as Adobe Pro programs

PHYSICAL REQUIREMENTS

Prolonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.

BENEFITS

401K (4% Match, Immediate Vesting)

Accident insurance

Competitive salary

Critical Illness Insurance

Dental Insurance

Employee Assistance Program

Flexible Spending Account

Health & Wellness Program

Health Savings Account

Life & AD&D Insurance

Long Term Disability

Medical Insurance

Paid Time Off

Pet Insurance

Short Term Disability

Vision Insurance

PRE-EMPLOYMENT SCREENING

Drug Screen and Background Check Required

HEALTHONE IS AN EQUAL OPPORTUNITY EMPLOYER

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status, or any other status protected by state or federal law.