Clinical Delegation Coord

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary This position is responsible for leading, coordinating and participating in clinical delegation oversight audits of HCSCu2019s vendors, service providers, medical groups and/or delegated subcontracted providers reviewing adherence to regulatory and contractual requirements. The position also develops audit tools based on state and federal regulations, conducts the reviews in accordance with accreditation standards and clinical guidelines . Creates reports regarding audits, and analyzes, tracks and trends audit findings. Develops and monitors corrective actions and provides feedback to practitioners on performance. May support in drafting amendments to agreements. Required Job Qualifications: + Registered Nurse (RN), unrestricted license to practice in state. + 3 years managed care experience or health plan operations experience + Experience developing and analyzing reports. + Experience in performing delegation oversight and monitoring multiple delegated functions, state and products. + Experience interpreting and implementing accreditation standards (NCQA and URAC). + Experience to interpret and implement state and federal health insurance regulations. + Organizational skills. + Verbal and written communications skills to include delivering presentations. to committees and acting as company representative to subcontractor management (Vendors and Delegates). + PC experience to include Microsoft Office suite of applications (Word, Excel). Preferred Job Qualifications: + Bachelor degree in Nursing, Health Care Administration or health care field. + Experience in auditing accreditation standards and state and federal regulations. + Medicaid or Medicare experience. + Presentation application experience (such as PowerPoint) and database experience. + Project management experience including leading projects. + Experience in creating and writing processes, policy and procedures. Telecommute: This is a Telecommute (Remote) role: Must reside within 250 miles of the office or anywhere within the posted state. #LI-TELECOMMUTE #LI-SG1 Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting . The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. HCSC Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range $61,500.00 - $136,100.00 Exact compensation may vary based on skills, experience, and location. Join our talent community and receive the latest HCSC news, content, and be first in line for new job opportunities. Join our Talent Community. ( For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities. Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who arenu2019t afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity youu2019ll have to improve health care delivery in an open, collaborative environment. HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants. If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations. Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to

Created: 2026-02-12