Job Details

Overview

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The Enterprise Accreditation Specialist III is responsible for supporting the organization to obtain and maintain appropriate accreditations, distinctions and recognitions through NCQA, URAC or other accrediting bodies. This person will serve as the subject matter expert for various accreditations, including but not limited to NCQA Health Plan Accreditation, LTSS Distinction, Health Equity, UM, and Population Health. This person will work cross-functionallywith business owners to identify gaps and deficiencies between current processes and the accreditation requirements and assist in implementing any necessary mitigation activities as needed. They will also ensure all changes made by accrediting bodies are communicated and incorporated into business processes.

Essential Functions (Responsibilities)

• Serve as subject matter expert in accreditation standards, including NCQA Health Plan, LTSS Distinction, Health Equity, UM and Population Health.
• Clearly define deliverables associated with delegation agreements including appropriate responsible parties.
• Maintain a strong understanding of the business processes within the assigned Market.
• Collaborate with the business owners to obtain documents, reports, and materials for accreditation submission.
• Provide oversight and monitoring of all surveys and deliverables within assigned Market.
• Monitor, track, and document deliverables related to accreditation process by applying accreditation standards to CareSource processes and documents in conjunction with the business owners.
• Advise business areas on appropriate documentation and data analysis needs for required improvement opportunities to meet the NCQA standards.
• Maintain knowledge of NCQA standards and ensure changes are communicated and incorporated into business processes.
• Review and analyze documents, reports, and materials for submission and ensure accuracy prior to submission.
• Facilitate ongoing annual qualitative and quantitative analyses, assuring business owners act on opportunities for improvement.
• Prepare materials for submission to accrediting entities, coordinating efforts with internal business owners, and tracking readiness against work plans and timelines.
• Manage survey submission process for the assigned Market.
• Maintain accreditation roadmaps/workplans.
• Identify and communicate survey status, gaps, escalations and ensure mitigation plans are implemented, gaps are closed and escalations resolved.
• Provide management recommendations for improvement related to accreditation processes and document processes.
• Ensure all workplans and dashboards are updated for reporting.
• Manage and execute on multiple module activities.
• Perform a variety of complex work in planning, coordinating, and managing accreditation activities.
• Provide education to staff and business owners on accreditation standards and timely updates to affected departments including survey dates and timelines for deliverables.
• Act as a mentor to the Accreditation Specialist II.
• Assist with onboarding of new team members on module and Market-specific requirements.
• Participate in Market Quality Committees and other applicable committees as required.
• Perform any other job duties as assigned.

Education And Experience

• Bachelors degree in science, arts, healthcare or other related field or equivalent years of relevant work experience is required.
• Minimum of three (3) years of experience in a Managed Care Organization or other healthcare related field is required.
• Project Management Experience is preferred.
• Accreditation experience is required.
• Knowledge of IHI, DMAIC, or other process improvement methodologies preferred.

Competencies, Knowledge And Skills

• Knowledge of accreditation bodies and various forms of accreditations, distinctions and recognitions.
• Expert knowledge of the NCQA Submission process.
• Strong interpersonal skills and high level of professionalism.
• Strong critical thinking/listening skills.
• Excellent problem-solving skills with strong attention to detail.
• Excellent written and verbal communication skills.
• Ability to work independently and within a team environment.
• Ability to develop, prioritize and accomplish goals.
• Analytical and organizational skills.
• Ability to coordinate complex projects and multiple meetings.
• Proficient in Microsoft Office Suite to include Word, Excel, Adobe Pro and SharePoint.
• Proficient knowledge of the healthcare field and with Medicaid, Medicare, and Marketplace.
• Training/teaching and technical writing skills.

Licensure And Certification

• None

Working Conditions

• General office environment; may be required to sit or stand for extended periods of time.

Compensation

Compensation Range

$61,500.00 - $98,400.00

CareSource takes into consideration a combination of a candidates education, training, and experience as well as the positions scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employees total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type
Salary

Competencies

• Create an Inclusive Environment - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Other

Industries

• Insurance

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