Opportunity to drive Quality improvement initiatives and Accreditation process for NCQA and URAC for our client - a fast growing specialty benefits management company (a wholly owned subsidiary of #1 managed care organization).
Serves as point of contact, coordinating and collaborating with URAC and NCQA accreditation entities and business partners to ensure compliance with accreditation requirements. Prepares enterprise for accreditation submissions and reviews.
**Serves as the SME for applicable accreditation standards.
**Develops tools that assist in determining exposure to accreditation risks and identifies opportunities to manage and mitigate those risks.
**Compiles information related to quality improvement and accreditation monitoring activities for internal use and external audits and maintains relevant records.
**Monitors improvement action plans relating to accreditation compliance.
**Works with business management areas to develop metrics for monitoring program objectives and policies and procedures that support compliance with accreditation requirements.
**Responsible for the maintenance of the electronic distribution and housing of all related policies and procedures.
**Provides guidance and input to business unit audit functions to ensure ongoing accreditation and quality compliance.
**Makes recommendations to business unit partners for improvements or remediation to accreditation compliance programs.
**Monitors development and use of metrics for accreditation compliance and required quality improvement activities.
**Assists with the development and maintenance of all required annual Quality Program Documents serving as the accreditation SME for URAC and NCQA documentation requirements.
**Collaborates with quality teams, utilization management teams, call centers and other departments on accreditation and quality improvement initiatives.
**Provides primary supports of quality committee activities. Includes reporting on the department’s activities to the Quality Committee quarterly.
**Assists with new hires, training, and coaching of unit associates
**Participates in the budget process as needed.
Ideal candidate will have
5+ years of experience in a managed care or healthcare-related experience
Significant knowledge of URAC and NCQA accreditation requirement
Project management experience
Successful NCQA/URAC accreditation process completion and continuous process improvement experience
5+ years’ experience in a QA/QI related position
Relocation available for the ideal candidate.
Max Populi, LLC
4628 Bayard Street, #207
Pittsburgh, PA 15213-2750
Tel: (412) 567-5279
Fax: (412) 567-5198