Healthcare Standards Administrator – SPSA, Opt. 8N

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Supervisor for Health Care Standards in the Department of Healthcare and Family Services overseeing healthcare compliance and investigations. Requires Registered Nurse licensure and extensive healthcare oversight experience.

Posted 6/24/2026full-timeSpringfield • Illinois • 🇺🇸 United StatesMid-LevelSenior💰 $10,000 - $12,500 per yearWebsite

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Hard Skills

Registered Nursemedical codingquality reviewutilization reviewcorrective action planshealthcare compliancemedical record reviewproject managementhealth insurance regulations

Soft Skills

supervisory experiencecommunication skillsinterpersonal skillsorganizational skillsdecision making

Certifications & Qualifications

Certified Professional Coder

Industry Keywords

Health Care StandardsOffice of the Inspector Generalmanaged care organizationsmedical necessitycase evidencecontractual agreementshealthcare oversight

About the role

Key responsibilities & impact

Serves as Heath Care Standards Administrator for the Office of the Inspector General (OIG) by planning, executing, controlling, and directing the statewide Health Care Standards Section
Serves as a full line supervisor
Receives and reviews case referrals from OIG bureaus, managed care organizations, external auditors, federal, state, and local law enforcement, community organizations, or individuals
Directs and reviews the assignment of professional nursing staff and other contractual medical professionals to conduct investigations
Plans, schedules, and attends Medical Quality Review Committee meetings to review case evidence gathered and documented to determine/recommend sanctions
Interviews, hires, and enters into contractual agreements with medical professionals
Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above

Requirements

What you’ll need

Requires licensure as a Registered Nurse in the State of Illinois
Requires knowledge, skill and mental development equivalent to the completion of four (4) years of college with coursework in nursing
Requires prior experience equivalent to four (4) years of progressively responsible professional nursing experience in a public or business organization
Three (3) years of professional supervisory experience related to health care oversight
Three (3) years of professional experience reviewing medical records for quality of care
Three (3) years of professional experience reviewing medical records clinical criteria for decision making for utilization review
Three (3) years of professional experience assessing medical services to validate appropriateness using established criteria and guidelines and ensuring the medical necessity of treatments
Three (3) years of professional experience developing and monitoring plans of corrective action
Three (3) years of professional experience in managing multiple projects and priorities to adhere to deadlines and time frames
Three (3) years of professional experience ensuring compliance with healthcare standards
Four (4) years of professional experience working with government health insurance rules and regulations
Certified Professional Coder for Medical billing or three (3) years of extensive medical coding experience
Three (3) years of experience utilizing professional written and verbal communications skills for external and internal stakeholders.

Benefits

Comp & perks

Health, Life, Vision, and Dental Insurance
Pension Plan
Paid Parental Leave
Deferred Compensation Program and other pre-tax benefit programs (Medical/Daycare)
Employees earn (12) paid Sick Days annually.
New Employees earn (10) paid Vacation Days their first year of service and can earn up to (25) paid Vacation Days annually.
Employees earn (3) paid Personal Days annually.
(13-14) paid holidays annually (based on start date)