Reporting to the Director, Enterprise Accreditation Programs and the Director, Quality Management, the Accreditation Specialist will serve as a business analyst to ensure system and process compliance with NCQA accreditation standards for all health plans. This position will also assist with preparation of documents and survey process to enable successful accreditation reviews. The position will monitor and establish a catalogue process for medical management policies for the assigned line of business.
Specific duties are, but not limited to:
Interfaces with all departments to ensure process compliance and execution of required processes; influences design of processes and related documentation to ensure compliance with new standards and changes to existing standards.
Serves as a Line of Business SME for accreditation.
Oversee new and existing standards to ensure compliance to NCQA standards across all impacted functional areas; support the design, implementation, and ongoing monitoring of policies, leads process improvement, systems, and processes required to remain compliant.
Completes a gap assessment of new standards at least annually.
Tracks performance against requirements and ensures compliance through continual review, audit and monitoring.
Maintains knowledge of company policies and procedures to ensure compliance and support of standards in all levels of government (Local, State & Federal).
Accreditation includes, but is not limited to, NCQA Health Plan accreditation and NCQA Multicultural Health Care Certification.
Bachelor's degree in an appropriate discipline or equivalent education and experience preferred.
Registered Nurse preferred.
Licensed Practical Nurse with the appropriate education and experience required.
Progressive healthcare experience including accreditation compliance with NCQA, URAC or JAHCO preferred.
Strong written and oral communication skills, critical thinking skills, proficiency in Microsoft Office products, strong organizational skills.
Progressive healthcare experience including accreditation compliance in managed care.
Project management experience in a healthcare or managed care setting.
Strong written, oral and presentation communication skills, critical thinking skills, proficiency in Microsoft Office products, strong organizational skills.
Internal Number: 14039
About AmeriHealth Caritas Louisiana
AmeriHealth Caritas is the nation's leader in providing comprehensive health care solutions for those in most need and the chronically ill. We impact the lives of more than 5.3 million members nationwide. With more than 30 years of experience managing care for individuals and families in publicly-funded programs, we have become known for developing innovative solutions that help improve health outcomes while reducing costs.
Our mission is to help people get care, stay well and build healthy communities. Our goal is to provide responsible managed care solutions, including Medicaid, Medicare, and CHIP - plus behavioral health, pharmacy benefits management and third-party management and administrative services.