Job Summary: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-functionally with 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: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 partiesMaintain a strong understanding of the business processes within the assigned MarketCollaborate with the business owners to obtain documents, reports, and materials for accreditation submissionProvide oversight and monitoring of all surveys and deliverables within assigned MarketMonitor, track, and document deliverables related to accreditation process by applying accreditation standards to CareSource processes and documents in conjunction with the business ownersAct as advisor to business areas on appropriate documentation and data analysis needs for required improvement opportunities to meet the intent of the NCQA standardsMaintain an in-depth knowledge of the standards within the scope of work and ensure that changes made by NCQA are communicated and incorporated into business processesReview and analyze documents, reports, and materials for submission. Ensures accuracy prior to submissionFacilitate ongoing annual qualitative and quantitative analyses, assuring business owners are acting on their opportunities for improvementResponsible for preparing materials including but not limited to updating and reformatting for submission to accrediting entities in accordance with standards, coordinating efforts with internal business owners, and tracking readiness against work plans and timelinesManage survey submission process for assigned MarketMaintain accreditation roadmaps/workplansIdentify and communicate survey status, gaps, and escalations and ensure mitigation plans are implemented, gaps are closed and escalations are resolvedProvide management recommendations for improvement related to accreditation processes and document processesEnsure all workplans and dashboards are updated for reportingManage and execute on multiple module activitiesconsistencyPerform a variety of complex work in planning, coordinating, and managing accreditation activitiesProvide education to staff and business owners on accreditation standards and provide timely updates to affected departments including accreditation activities, survey dates and timelines for deliverablesAct as a mentor to the Accreditation Specialist IIAssist with the onboarding of new team members on module and Market specific requirementsParticipate in Market Quality Committees and other applicable committees as requiredPerform any other job duties as assignedEducation and Experience:Bachelor’s 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 requiredProject Management Experience is preferredAccreditation experience is requiredKnowledge of IHI, DMAIC, or other process improvement methodologies preferredCompetencies, Knowledge and Skills:Knowledge of accreditation bodies and various forms of accreditations, distinctions and recognitions.Expert knowledge of the NCQA Submission processStrong interpersonal skills and high level of professionalismStrong critical thinking/listening skillsExcellent problem-solving skills with strong attention to detailExcellent written and verbal communication skillsAbility to work independently and within a team environmentAbility to develop, prioritize and accomplish goalsAnalytical and organizational skillsAbility to coordinate complex projects and multiple meetingsProficient in Microsoft Office Suite to include Word, Excel, Adobe Pro and SharePointExcellent written and verbal communication skillsProficient knowledge of the healthcare field and with Medicaid, Medicare, and MarketplaceTraining/teaching and technical writing skillsLicensure and Certification:NoneWorking Conditions:General office environment; may be required to sit or stand for extended periods of timeCompensation Range:$62,700.00 - $100,400.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s 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 employee’s total well-being and offer a substantial and comprehensive total rewards package.Compensation Type (hourly/salary):SalaryOrganization Level Competencies Fostering a Collaborative Workplace CultureCultivate PartnershipsDevelop Self and OthersDrive ExecutionInfluence OthersPursue Personal ExcellenceUnderstand the BusinessThis 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 environment of belonging that welcomes and supports individuals of all backgrounds.#LI-JM1About UsThe CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers.We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day.The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.
25 days ago