Responsible for providing accreditation services necessary for attaining and maintaining accreditation from various accrediting organizations, such as NCQA, AAAHC and or URAC. These functions should support the end-to-end survey process in preparing internal team members for surveys, address staff survey inquiries, conduct accreditation and certification mock surveys, and assist in responding to comments on the preliminary survey results. Responsible for assisting in activities pertaining to meeting and maintaining compliance with NCQA standards and regulations from regulatory bodies. Maintain, review and revise the comprehensive interdisciplinary plan for constant regulatory readiness for CHRISTUS Health Plan & Networks multi-disciplinary teams. Assists with accreditation and regulatory education and training of associates and the leadership team. Assists with meeting annual goals and objectives for the department. Additional duties include but are not limited to serving as the regulatory backup for the Accreditation Manager during survey needs, as required and other duties based on regulatory and compliance needs.
Assists in the development, implementation, measurement and tracking of complex cross-functional NCQA accreditation activities to ensure compliance with NCQA standards and regulatory requirements. Works collaboratively with other departments to ensure a comprehensive approach and have a shared understanding of roles and responsibilities
Interface with internal and external clients, quality committees, and departments in the review of quality improvement data and implementation of appropriate interventions to effect improvement.
Evaluates, interprets and summarizes accreditation guidelines and manage the process for accreditation activities.
Coordinates activities for successful accreditation surveys.
Collaborates with and influences operational managers to resolve continued non-compliant standards.
Assists in collecting and maintaining required documentation (evidence) in compliance with these standards and utilizes feedback to update policies/procedures/operations accordingly
Organizes and participates in readiness assessments to prepare for accreditation survey submissions
May interface with accreditation agencies and other regulatory and compliance bodies in absence or at the direction of manager
As needed, assist in coordination of mock file reviews as required by assigned NCQA accreditation standards
Provides recommendations on results of file review to ensure compliance with NCQA standards
Serves as a technical advisor and SME in the absence of manager
Bachelors in a health care field
Minimum of 3 years healthcare-related experience, in addition, minimum of 1 year experience in managed care related to health plan quality; or any combination of education and experience, which would provide an equivalent background.
NCQA and URAC accreditation process experience strongly preferred.
2+ years of experience and solid knowledge ambulatory and health plan quality
2+ years of solid, documented experience in successfully preparing and submitting NCQA Health Plan accreditation surveys
2+ years of experience in quality improvement
Knowledge or experience in AAAHC requirements preferred
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.