AmeriHealth Caritas Responsibilities: in Philadelphia, Pennsylvania

Responsibilities:

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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.

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  • 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

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  • Serves as a Line of Business SME for accreditation.

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  • 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, systems, and processes required to remain compliant. Complete a gap assessment of new standards at least annually.

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  • Tracks performance against requirements and ensures compliance through continual review, audit and monitoring.

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  • Maintains knowledge of company policies and procedures to ensure compliance and support of standards in all levels of government (Local, State & Federal).

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  • Accreditation includes, but is not limited to, NCQA Health Plan accreditation and NCQA Multicultural Health Care Certification.

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Education/Experience:

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  • Registered Nurse preferred.

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  • Registered Nurse preferred.

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  • 3- 5 years Progressive healthcare experience including accreditation compliance.

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  • Strong written and oral communication skills, critical thinking skills, proficiency in Microsoft Office products, strong organizational skills.

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Accreditation Specialist

Location: Philadelphia, PA

Telecommuter?: Yes

ID**: 14296

Job Brief

serve as a business analyst to ensure system and process compliance

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us atwww.amerihealthcaritas.com.

Responsibilities:

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.

  • 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, systems, and processes required to remain compliant. Complete 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.

Education/Experience:

  • Registered Nurse preferred.

  • Registered Nurse preferred.

  • 3- 5 years Progressive healthcare experience including accreditation compliance.

  • Strong written and oral communication skills, critical thinking skills, proficiency in Microsoft Office products, strong organizational skills.

EOE Minorities/Females/Protected Veterans/Disabled