Accreditation Program Manager
Martin's Point Health Care
REQ-2020-072
5d ago

Job Profile Summary

The Accreditation Program Manager is responsible for ensuring compliance with all designated accreditation standards and ensuring ongoing accreditation readiness.

The primary focus of this role is to conduct ongoing evaluation of all health plan program activities to measure and improve the quality of care and services provided to members in alignment with accreditation standards

Key Outcomes :

  • Management and coordination of the accreditation processes across the organization to ensure compliance with accrediting bodies and governing agencies such as the Department of Defense (DOD) requirements and CMS
  • Demonstrates understanding of accreditation standards and remains current with all updates to accreditation standards
  • Facilitates implementation. provides ongoing guidance and training to staff and monitors status of compliance with new & existing accreditation standards and requirements.
  • Acts as the liaison to accreditation bodies for coordination of required submissions and responses to survey results.
  • Responsible for submitting accreditation documentation, and coordinating all aspects of on-site or virtual visits
  • Promotes and builds quality improvement processes / project plans and Standard Work into the organizational structure and workflow consistent with accreditation and CMS requirements, best practices and strategic objectives
  • Utilizes process improvement tools & methodologies to ensure consistent application for quality initiatives.
  • Assists with the development of the annual quality program, plan and evaluation.
  • Supports the accomplishment of strategic plans that achieve high impact and significant improvements in organizational performance which includes but is not limited to HEDIS measures, Star Rating, and NCQA Health Plan Accreditation and Health Plan Rating.
  • Measures and evaluates results, creates reports that identify risks and readiness for accreditation
  • Leads problem-solving activities for identified areas of accreditation risk
  • Works with quality committee chairs to prepare agendas, facilitate quality meetings, ensure accuracy of meeting minutes, update charters, provide meeting materials to all attendees prior to meetings, and extend meeting invitation to appropriate outside entities as required.
  • Coordinates and / or conducts training to ensure key stakeholders understand the requirements to meet accreditation goals.
  • Participates in HEDIS medical record review and failure analysis
  • Works collaboratively with other HP or DS teams on initiatives to improve outcomes that impact Accreditation or Health Plan Rating
  • Understands organizational clinical and operational activities related to HEDIS, health plan rating and accreditation measures to ensure alignment and identify opportunities for collaboration
  • Conducts investigations and documentation of QOCs as needed.
  • Participates in and presents at PAG meetings as necessary
  • Participates in DHA on-site visit
  • Develops high level understanding of all functions within quality programs
  • Manages external vendors as needed for improvement activities
  • Education / Experience :

  • Registered nurse required.
  • MHA or MBA preferred
  • Minimum of 5 years of experience in managed care.
  • Experience with government programs, accreditation, HEDIS, CAHPS and health care quality preferred.
  • Project management experience preferred
  • Skills / Knowledge / Competencies (Behaviors) :

  • Demonstrates an understanding of and alignment with Martin’s Point Values.
  • Strong knowledge of CMS / DHA / Health Care Quality and Provider metrics and incentives
  • Able to design Standard Work processes around customer needs and expectations, measure results, and improve systems when target not met.
  • Excellent customer service focus : Team oriented individual with a high level of interpersonal skills, and the ability to relate to all internal and external customers in a positive and professional manner while establishing accountability.
  • Knowledge of the health care industry, managed care operations, USFHP program administration and compliance
  • Ability to apply leadership strength and critical thinking to short-term, mid-range and long-term goals
  • Superior communication skills, both written and verbal, for internal and external audiences
  • Extensive analytical skills and the ability to use data to drive improvement activities
  • Knowledge of data warehousing concepts, applications, and tool-sets
  • Effective presentation of reporting and analytic results using a variety of tools
  • Knowledge of standard health care metrics for payer and provider reporting
  • Fair and Flexible, High Ethical Standards
  • Computer skills including Microsoft Word, Access, Excel, Visio, Outlook, and PowerPoint.
  • Skills in facilitation of work process improvement activities.
  • We are an equal opportunity / affirmative action employer.

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