Clinical Quality and Compliance Coordinator Maryland UM

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