Health Plan Accreditation Coordinator - Remote (Ak, Az, Id, Or, & Wa)

Job Title

Health Plan Accreditation Coordinator - Remote (AK, AZ, ID, OR, & WA)

Duration

Open Until Filled

Work From Home

Yes

Description

Let’s do great things, together Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.Under direction of the Manager Health Engagement and Quality Improvement and the Accreditation Specialist, the Accreditation Coordinator will assist with the management and planning of the National Committee for Quality Assurance (NCQA) Health Plan Accreditation process for Moda Health. Under set guidelines to meet the NCQA accreditation requirements leading to successful coordination of the accreditation for the health plan. Assists with the development and maintenance of a comprehensive accreditation project plan adhering to the standards, quality studies, prioritized interventions and on-going monitoring for compliance as established by NCQA for all accreditation requirements. Coordinates the efforts to earn outstanding clinical performance and positive customer experience as required for accreditation. This is a full-time remote position for candidates living or willing to relocate to the following States ONLY: AK, AZ, FL, ID, OR or WA. Please follow the link below to apply to this position:

• Https://j.brt.mv/jb.do?reqGK=27702218&refresh=true

Benefits:

• 401K- Matching
• Employee Assistance Program
• PTO and Company Paid Holidays
• FSA
• Medical, Dental, Vision, Pharmacy, Life, & Disability

Primary Functions:

• Works with all areas of the health plan, e.g., leadership, senior management, clinical, network, and quality improvement.
• Assists with training and coaching to support understanding of accreditation standards and requirements.
• Coordinates with establishing set guidelines to meet NCQA accreditation requirements.
• Performs other duties as assigned.
• Assist with the maintenance of a comprehensive project plan linked to standards with on-going monitoring and reporting to health plan leadership and senior management as necessary.
• Maintains the accreditation and audit document library.
• Coordinates communication of information among {governance} committees and serves as SME on accreditation issues and changing standards.
• Working knowledge of program management, analysis and evaluation of the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.
• Coordinates audit activities to ensure accreditation compliance such as department wide on-site surveys.
• Coordinates activities to collect member and provider input as needed for accreditation purposes {working with vendors and auditors}.
• Coordinates the development and revisions of policies and procedures to comply with NCQA guidelines and regulatory standards.
• Coordinates activities with subject matter experts (SME) and business owners.
• Understands the relationship between NCQA, Affordable Care Act (ACA), and Centers of Medicare and Medicaid (CMS) as it relates to specific NCQA Accreditation requirements.
• Develops and leads a regulatory survey readiness program planning process in support of the organization’s mission, core values, and business objectives.

Required Skills:

• Proficiency using Microsoft Office (Access, Excel, Word, and PowerPoint)
• Three (3) years of experience in a Managed Care Organization (MCO), large hospital or healthcare system {is required/preferred}.
• Two (2) years of experience with accreditation and regulatory survey process, development, and follow-up of corrective plans {is required/preferred}.
• Bachelor's degree from a four-year accredited university
• One (1) year of program management experience {is required/preferred}.

Preferred:

• Experience with the successful completion of the NCQA accreditation process resulting in a fully accredited designation is preferred
• Experience implementing accreditation standards for a Managed Care Organization (MCO) such as Medicaid and the Affordable Care Act is preferred.
• Experience in coordinating a broadly integrated process related to achieving accreditation standards is preferred.
• Experience in coordinating accreditation plans in a healthcare environment is preferred.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our [email protected] email.

Pay Range

¤22.00 Hourly to ¤25.25 Hourly