NCQA Quality & Accreditation Specialist

The NCQA Quality and Accreditation Specialist is responsible for supporting the maintenance of accreditation for the Utilization Management and Credentialing departments. This includes developing and implementing quality improvement initiatives, conducting audits and reviews, and preparing reports. The ideal candidate will have a strong understanding of accreditation standards and a commitment to quality improvement. The position will report to the Director of Utilization Management and Credentialing and work closely with other departments to ensure quality and compliance with accreditation standards. The role will be responsible for coordinating accreditation activities, implementing quality improvement initiatives, and providing education to staff.

Salary: $80,000/annual

JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES

The NCQA Quality and Accreditation Specialist’s responsibilities include but are not limited to:

• Develop and implement quality improvement initiatives to improve the quality of care provided by the UM and Credentialing teams.
• Coordinate accreditation activities for the Utilization Management and Credentialing departments, including preparing documentation, conducting internal audits, and participating in external audits.
• Monitor and analyze data to identify trends, opportunities, and areas for improvement.
• Participate in the development and maintenance of policies and procedures related to Utilization Management and Credentialing.
• Maintain knowledge of current accreditation standards and regulatory requirements.
• Support the Director of Utilization Management and Credentialing in the planning and execution of accreditation-related initiatives.
• Coordinate and lead cross departmental committee meetings
• Prepare reports on the findings of audits, review, and program performance evaluations.
• Provide education and training to staff on accreditation standards and quality improvement initiatives.
• Serve as a liaison between the Utilization Management and Credentialing departments and the accreditation organization.
• Produce client ready documents that summarize findings and recommendations
• Develop, revise and annually review policies and procedures for operational and clinical compliance.
• Collaborate with other departments to identify and address issues.
• Maintain compliance with all accrediting agency standards such as NCQA, CMS and State agencies
• Strong organizational skills, ability to adapt quickly to change and desire to work in a fast-paced environment
• Team oriented and self-motivated with a positive attitude
• Performs other duties as assigned

EDUCATION:

• Bachelor's degree in health care administration, public health, or a related field.
• 3+ years of experience in quality improvement, accreditation, or a related field.

EXPERIENCE:

• Strong understanding of accreditation standards.
• Excellent written and verbal communication skills to convey information clearly and consistently.
• Ability to work independently and as part of a team.
• Strong organizational and time management skills.
• Experience in New York Medicare and Medicaid requirements.
• Minimum of 3 years in quality management, accreditation, and/or compliance in a health plan setting.
• Knowledge of regulatory requirements related to utilization management, such as CMS and NCQA standards
• Strong communication, leadership and analytical skills
• Ability to work effectively in a fast paced, team-oriented environment
• Proficiency in Microsoft Office application and health plan systems