Clinical Quality and Compliance Coordinator Maryland UM

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.

What you'll do

• 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

Required Skills and Experience

• 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 Skills and Experience

• 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