NCQA Quality & Accreditation Specialist

Location

Troy, MI | United States

Job description

The Quality and Accreditation Specialist is responsible for supporting the maintenance of accreditation for the Utilization Management and Credentialing departments. This includes developing and implementing quality improvement initiatives, conducting audits and reviews, and preparing reports. The ideal candidate will have a strong understanding of accreditation standards and a commitment to quality improvement. The position will report to the Director of Utilization Management and Credentialing and work closely with other departments to ensure quality and compliance with accreditation standards. The role will be responsible for coordinating accreditation activities, implementing quality improvement initiatives, and providing education to staff.

Salary: $80,000/annual

                                       JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES

The Quality and Accreditation Specialist’s responsibilities include but are not limited to:

• Develop and implement quality improvement initiatives to improve the quality of care provided by the UM and Credentialing teams.
• Coordinate accreditation activities for the Utilization Management and Credentialing departments, including preparing documentation, conducting internal audits, and participating in external audits.
• Monitor and analyze data to identify trends, opportunities, and areas for improvement.
• Participate in the development and maintenance of policies and procedures related to Utilization Management and Credentialing.
• Maintain knowledge of current accreditation standards and regulatory requirements.
• Support the Director of Utilization Management and Credentialing in the planning and execution of accreditation-related initiatives.
• Coordinate and lead cross departmental committee meetings
• Prepare reports on the findings of audits, review, and program performance evaluations.
• Provide education and training to staff on accreditation standards and quality improvement initiatives.
• Serve as a liaison between the Utilization Management and Credentialing departments and the accreditation organization.
• Produce client ready documents that summarize findings and recommendations
• Develop, revise and annually review policies and procedures for operational and clinical compliance.
• Collaborate with other departments to identify and address issues.
• Maintain compliance with all accrediting agency standards such as NCQA, CMS and State agencies
• Strong organizational skills, ability to adapt quickly to change and desire to work in a fast-paced environment
• Team oriented and self-motivated with a positive attitude
• Performs other duties as assigned

EDUCATION:

• Bachelor's degree in health care administration, public health, or a related field.
• 3+ years of experience in quality improvement, accreditation, or a related field.

EXPERIENCE:

• Strong understanding of accreditation standards.
• Excellent written and verbal communication skills to convey information clearly and consistently.
• Ability to work independently and as part of a team.
• Strong organizational and time management skills.
• Experience in New York Medicare and Medicaid requirements.
• Minimum of 3 years in quality management, accreditation, and/or compliance in a health plan setting.
• Knowledge of regulatory requirements related to utilization management, such as CMS and NCQA standards
• Strong communication, leadership and analytical skills
• Ability to work effectively in a fast paced, team-oriented environment
• Proficiency in Microsoft Office application and health plan systems

Benefits Offered

• Competitive compensation and annual bonus program
• 401(k) retirement program with company match
• Company-paid life insurance
• Company-paid short term disability coverage (location restrictions may apply)
• Medical, Vision, and Dental benefits
• Paid Time Off (PTO)
• Paid Parental Leave
• Sick Time
• Paid company holidays and floating holidays
• Quarterly company-sponsored events
• Health and wellness programs
• Career development opportunities

Our Story

Founded in 2005, Integra Partners is a leading network management company specializing in Orthotics, Prosthetics, and Durable Medical Equipment. We are reimagining access to in-home healthcare to improve the quality of life for the communities we serve.

With locations in New York City, Michigan, and a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We’re looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you.

Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.

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