Working under general supervision, the Manager, Accreditation is responsible for developing and implementing processes to support ongoing compliance with National Committee for Quality Assurance (NCQA) health plan accreditation, as well as the Multicultural Health Care Distinction. The manager will coordinate accreditation preparedness and maintenance activities to ensure continual readiness for accreditation. The manager supports the ongoing monitoring of NCQA and related regulatory standards and oversees the ongoing review of compliance with new and existing standards. In addition, the manager will monitor for opportunities for improvement to assure full standards compliance in all measured areas by the stakeholders and management staff of all business units. The manager continually updates all key stakeholders on changes to standards or processes and leads activities to reach compliance with those new/revised standards. The manager will directly report to the VP, Chief Quality Officer (CQO).
Serve as subject matter expert to key Health Partners Plans business units regarding accreditation standards, revisions in accreditation standards, and regulatory standards and requirements as identified through internet, literature review, standard review and conference resources
Oversee the ongoing completion of accreditation document submission and preparation of documentation for scheduled surveys and other regulatory audit activity
Collaborate with Compliance to ensure timely submission of required reports and data
Provide oversight of all preparations for accreditation surveys that may include but is not limited to:
Surveyors on site needs
Oversee mock audits
Utilize external consultants to review documents for standards compliance, as well as file review during accreditation preparation. Internally, samples of file reviews take place year round to assess documentation and ensure readiness for surveys
Seek and track corrective action to resolution based on assessed levels of readiness and compliance.
Calculate awarded points on a regular basis, based on mock review and HEDIS/CAHPS scores to update the Vice President.
Support Quality Management Committee and Delegated Vendor Oversight Sub-Committee through monitoring committee review of key documents and processes and monitoring the maintenance of documentation that reflects the activities and decisions of all QI committees
Chair the Service Quality Committee
Oversee the accreditation functions of pre-delegation, as well as the annual and semi-annual delegation audits
Present information and regular reports to management and QI committees on the accreditation maintenance plan and status of accreditation compliance and preparedness
Collaborate with HPP management teams on any/all regulatory activity
Ensure the dissemination of current accreditation standards and related regulatory requirements to HPP key stakeholders and departmental owners
Monitor HPP’s’ clinical and service initiatives and programs for compliance with accreditation and regulatory requirements
Support ongoing monitoring of NCQA compliance by:
Ensuring that appropriate documentation of quality of care and service initiatives and activities are maintained and reflect compliance with accreditation requirements
Reviewing any changes to existing business or technical workflows with business owners to ensure that any changes do not compromise NCQA compliance.
Serve as a NCQA resource lead in response to any new or existing measures requiring significant technical /business workflow changes or guidance
Communicate accountability to all management in affected business units to ensure accreditation readiness and compliance.
Oversee the coordination of all accreditation needs with Corporate Communications across all standards business owners to ensure completion and accuracy of the information. May include but is not limited to member and provider newsletters and web posting.
Facilitate intra-departmental workgroups to establish and monitor corrective action plans, interventions, process changes around annual reports (CAHPS analysis, GEO, Access and Availability, Complaints and Grievances, Referral analysis, Medical Record Review analysis,).
Develop and implement an ongoing workplan for standards to ensure ongoing preparedness for accreditation.
Oversee the coordination of all accreditation surveys which may include but is not limited to :
the Multicultural Healthcare distinction awarded by NCQA for a 2 year cycle
NCQA Health Plan accreditation awarded by NCQA every 3 years
Interface with health plan executive leadership, especially during active accreditation periods and pre-onsite preparatory sessions.
Coach and lead team to continuously improve operational performance outcomes.
Maintain a positive work environment that supports self-direction; provide a structure to optimize experience, skill, knowledge and capability of the team.
Reward team members based on contribution and performance.
Maintain and foster a collaborative relationship with internal and external customers.
Champion process improvement initiatives, identify and seek best industry practices to share with line management.
Build and administer business plans, control expenses, manage budget and increase profitability to meet established business and corporate goals
Manage cross-functional employees to meet and exceed service requirements and functional objectives.
Recruit, develop, motivate and retain a high caliber of team members to effectively meet corporate objectives.
Perform other duties as assigned.Supervisory Responsibility: This position has overall supervisory responsibility for registered nurses, clerical staff and/or related personnel during active survey preparation.
Work Environment: This job operates in an office setting. This role requires regular walking to various locations around the office building.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Able to work in a constant state of alertness and safe manner.
While performing the duties of this job, the employee is regularly required to talk and hear. This position requires standing, walking, sitting and working on a computer and monitor. The position requires minimal lifting.
Occasional travel is required for this position.
Work from Home
This position affords occasional work from home with the VP’s approval.
Required Education and Experience:
Education: Bachelor’s degree required; RN licensure or other healthcare related degree required.
Experience: 2-3 years’ accreditation and or regulatory experience required, NCQA accreditation experience required, and a minimum of 1 years’ management experience. Knowledge of State of Pennsylvania Department of Health (DOH) and Department of Human Services (DHS) and, Center for Medicaid and Medicare Services (CMS) preferred.
Strong verbal and written communication skills. Strong analytical skills Proficiency in project management, team leadership and participation, and facilitation. Ability to work with multiple individuals and departments to communicate project goals and coach towards completion. Ability to interact with all levels of management to attain readiness for accreditation of all business units.
Strong organizational skills; attention to detail. Word processing, database and spreadsheet knowledge required. Strong ability to work independently, self motivated.
Medicare Advantage Compliance Statement:
Compliance with all applicable rules, regulations and laws is a condition of employment. Employees must read and sign, both the Business Code of Conduct and the Personal Standard Code of Conduct, and are expected to perform their duties ethically and honestly.
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for their job. Duties, responsibilities, and activities may change at any time with or without notice.
Telecommuting is allowed.
Internal Number: 1021
About Health Partners Plans
Health Partners Plans is an award-winning, not-for-profit health maintenance organization serving more than 280,000 members in Bucks, Chester, Delaware, Lancaster, Lehigh, Montgomery, Northampton, and Philadelphia counties.
We offer Medicaid, Medicare and Children’s Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We’re also committed to boosting the health of our community through outreach, education and events.
We continually develop new ways to encourage better health outcomes and have received national recognition for our innovations in managed care.