Enterprise Accreditation Specialist III

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $62.7k - $100.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Support the organization in obtaining and maintaining accreditations, distinctions, and recognitions through NCQA, URAC, and other accrediting bodies • Serve as subject matter expert for NCQA Health Plan Accreditation, LTSS Distinction, Health Equity, UM, and Population Health • Identify gaps and deficiencies between current processes and accreditation requirements with business owners • Assist with implementing mitigation activities and incorporating accrediting-body changes into business processes • Define deliverables associated with delegation agreements and identify responsible parties • Collaborate with business owners to obtain documents, reports, and materials for accreditation submissions • Oversee and monitor surveys and deliverables within the assigned Market • Track and document accreditation deliverables against CareSource processes and documents • Advise business areas on documentation and data-analysis needs for improvement opportunities • Review and analyze submission materials and ensure accuracy before submission • Facilitate annual qualitative and quantitative analyses and ensure business owners act on improvement opportunities • Prepare, reformat, and submit materials to accrediting entities while coordinating internal owners and tracking readiness • Manage survey submission processes for the assigned Market • Maintain accreditation roadmaps and workplans • Communicate survey status, gaps, and escalations; ensure mitigation plans are implemented and issues resolved • Provide management recommendations for accreditation-process improvements and document processes • Update workplans and dashboards for reporting • Manage and execute multiple module activities • Plan, coordinate, and manage complex accreditation activities • Educate staff and business owners on accreditation standards and provide updates on activities, survey dates, and deliverable timelines • Mentor Accreditation Specialist II staff • Assist with onboarding new team members on module- and Market-specific requirements • Participate in Market Quality Committees and other applicable committees

🎯 Requirements

• Bachelor’s degree in science, arts, healthcare, or another related field, or equivalent years of relevant work experience • Minimum of three years of experience in a Managed Care Organization or other healthcare-related field • Accreditation experience required • Project management experience preferred • Knowledge of IHI, DMAIC, or other process improvement methodologies preferred • Knowledge of accreditation bodies and various accreditations, distinctions, and recognitions • Expert knowledge of the NCQA submission process • Proficient in Microsoft Office Suite, including Word, Excel, Adobe Pro, and SharePoint • Proficient knowledge of the healthcare field and Medicaid, Medicare, and Marketplace • Training/teaching and technical writing skills • Strong interpersonal, critical thinking, listening, problem-solving, written communication, and verbal communication skills • Strong attention to detail • Ability to work independently and within a team environment • Ability to develop, prioritize, and accomplish goals • Analytical and organizational skills • Ability to coordinate complex projects and multiple meetings • No licensure or certification required

🏖️ Benefits

• Base salary range of $62,700.00–$100,400.00 per year • Potential bonus tied to company and individual performance • Substantial and comprehensive total rewards package • Support for employees’ total well-being • Remote work arrangement