Enterprise Accreditation Specialist III

This is a fully remote position, open to applicants in United States.

📋 Description

• Assist the organization in securing and upholding accreditations, distinctions, and recognitions through NCQA, URAC, and other accrediting entities.

• Act as the subject matter expert for NCQA Health Plan Accreditation, LTSS Distinction, Health Equity, UM, and Population Health.

• Identify discrepancies and shortcomings between existing processes and accreditation standards in collaboration with business owners.

• Aid in the execution of mitigation strategies and integrate changes from accrediting bodies into business operations.

• Specify deliverables linked to delegation agreements and determine accountable parties.

• Partner with business owners to gather documents, reports, and materials for accreditation submissions.

• Supervise and track surveys and deliverables within the assigned Market.

• Monitor and document accreditation deliverables in accordance with CareSource processes and records.

• Advise business areas on documentation and data-analysis requirements for identifying improvement opportunities.

• Review and evaluate submission materials to ensure accuracy prior to submission.

• Conduct annual qualitative and quantitative analyses, ensuring business owners address improvement opportunities.

• Prepare, format, and submit materials to accrediting organizations while coordinating with internal stakeholders and tracking readiness.

• Oversee survey submission processes for the designated Market.

• Maintain accreditation roadmaps and work plans.

• Communicate the status of surveys, identify gaps, and escalate issues; ensure implementation of mitigation plans and resolution of problems.

• Provide recommendations for enhancing the accreditation process and document procedures.

• Update work plans and dashboards for reporting purposes.

• Manage and execute multiple module activities.

• Plan, coordinate, and oversee intricate accreditation activities.

• Educate staff and business owners about accreditation standards and keep them informed about activities, survey dates, and timelines for deliverables.

• Mentor Accreditation Specialist II staff.

• Assist in onboarding new team members on module- and Market-specific requirements.

• Participate in Market Quality Committees and other relevant committees.

⛳️ Requirements

• Bachelor’s degree in science, arts, healthcare, or a related field, or equivalent years of relevant work experience.

• At least three years of experience in a Managed Care Organization or another healthcare-related field.

• Accreditation experience is mandatory.

• Project management experience is preferred.

• Familiarity with IHI, DMAIC, or other process improvement methodologies is preferred.

• Knowledge of accreditation bodies and their various accreditations, distinctions, and recognitions.

• Expert understanding of the NCQA submission process.

• Proficient in Microsoft Office Suite, including Word, Excel, Adobe Pro, and SharePoint.

• Solid knowledge of the healthcare sector, including Medicaid, Medicare, and Marketplace.

• Skills in training/teaching and technical writing.

• Strong interpersonal, critical thinking, listening, problem-solving, written and verbal communication abilities.

• Exceptional attention to detail.

• Capability to work independently and collaboratively within a team setting.

• Aptitude for developing, prioritizing, and achieving goals.

• Strong analytical and organizational skills.

• Ability to coordinate complex projects and manage multiple meetings.

• No licensure or certification is required.

🏝️ Benefits

• Base salary range of $62,700.00–$100,400.00 per year.

• Potential bonus linked to company and individual performance.

• Comprehensive and substantial total rewards package.

• Support for the overall well-being of employees.

• Remote work arrangement.