Telligen

Healthcare quality improvement and management services

Clinical Quality and Compliance Coordinator

Regulatory Compliance & EthicsPosted on Nov 11

Full-timeMaryland, USA$76k - $90k /yr

About the Job

Requirements

An active Registered Nurse or Licensed Practical Nurse license is required.
At least 2 years of experience in quality assurance or quality improvement, compliance, credentialing, or healthcare operations is required.
Working knowledge of URAC and/or NCQA standards is required.
Experience with clinical documentation review and audit processes is required.
A strong understanding of quality improvement methodologies, such as Plan-Do-Study-Act cycles, is required.

Responsibilities

Coordinate quality assurance, quality improvement, accreditation, regulatory compliance, and credentialing activities across Utilization Management, Case Management, and Disease Management clinical programs.
Provide hands-on support for audit activities, quality improvement initiatives, accreditation readiness, state regulatory filings, credentialing processes, and staff education.
Assist with developing and executing audit tools and education materials under direction, and support tracking, documentation, and monitoring to ensure compliance with URAC, NCQA, state regulatory, and contractual requirements.
Support quality assurance and quality improvement 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 cycles and other quality improvement initiatives.
Support corrective action plans 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 developing, maintaining, and refining audit tools, checklists, and templates under direction, including mapping them 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 collecting, organizing, and submitting accreditation and regulatory evidence.
Maintain accreditation trackers, compliance logs, and documentation repositories.
Support preparation and maintenance of state Utilization Review Organization applications, renewals, and amendments under direction.
Support credentialing and recredentialing activities for clinical staff and delegated entities.
Assist with primary source verification documentation collection and file organization.
Maintain credentialing logs, trackers, and audit documentation.
Support credentialing audits and corrective action activities as assigned.
Assist with developing and updating 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.

Desired Qualifications

A bachelor's degree in Nursing, Healthcare Administration, Public Health, or a related field is preferred.
Certification in healthcare quality or compliance, such as CPHQ or CPMSM, is preferred.
Experience supporting accreditation surveys, credentialing audits, and state Utilization Review Organization filings is preferred.

Salary Range: 76000 to 90000 (Currency: USD) (Pay period: per-year-salary)

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.

Telligen will consider candidates living in Iowa or Maryland. Telligen will consider internal candidates in other states.

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

Who We Are:

Telligen is one of the most respected population health management organizations in the country. We offer clinical, analytical, and technical expertise to support local, Tribal, and national partners, state and federal government programs, and employers and health plans.

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?

Benefits: A general description of the benefits and other compensation available for this position can be found in Telligen's Benefits Summary.

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!

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.

Telligen is an equal opportunity employer. Qualified applicants will be considered without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, protected veteran status, disability or any other protected class.

Telligen is committed to ensuring that our employment process is open to all individuals, and provides reasonable accommodations to individuals who need assistance during any part of the employment process due to a disability, medical condition, or physical or mental impairment. Reasonable accommodations are considered on a case-by-base basis.

If you need assistance to navigate Telligen’s careers website or to apply for a position, please send an email to [email protected]

About the Company

Telligen

Healthcare quality improvement and management services

Telligen is a healthcare management and quality improvement company that partners with U.S. government health agencies, state Medicaid programs, self-funded employer and Taft-Hartley plans, and managed care organizations to improve health outcomes through data analytics and clinical management. Its services span quality measurement and reporting, case and utilization management, chronic-condition and specialty health management, and wellness programs such as the National Diabetes Prevention Program, many delivered through its Qualitrac platform with modules for case management, quality measurement, utilization management, and PASRR. What sets Telligen apart is its pairing of proprietary technology with clinical expertise, backed by NCQA Population Health Program Accreditation and industry recognition. The goal is to help people live their healthiest lives by improving outcomes with proven management solutions.

Company size: Not listed
Company stage: Not listed
Total funding: Not listed
Headquarters: London, United Kingdom
Founded: Not listed

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