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DIRECTOR ACCREDITATION in Remote at Beacon Health Options

Date Posted: 2/12/2019

Job Snapshot

Job Description

We are currently seeking a dynamic Director, Accreditation to join our team!   The  Director, Accreditation  reports to the Vice President of Accreditation and is responsible for management of Regional Center adherence to the National Committee for Quality Assurance (NCQA) Managed Behavioral Health Organization (MBHO) and URAC Health Utilization Management, Case Management, and other URAC accreditations as they become necessary for specific contracts.

The role requires advanced knowledge and understanding of accreditation standards and requirements across all categories of accreditation (Utilization Management, Quality Improvement, Credentialing and Recredentialing, Member Rights and Responsibilities, Care Coordination. ,The Director of Accreditation provides guidance and leadership to the teams representing all Regional Centers of clinical, quality, network and other departments depending on particular standard. S/he is responsible for the development of training materials and delivering trainings to all staff included in accreditation.

This positon requires travel up to 10 times per year to regional offices and/or engagement centers.

Position Responsibilities:

  • Assist with coordinating accreditation preparation activities with internal departments, service centers and engagement centers on an ongoing basis.
  • Provide technical support and consultation on all NCQA and URAC accreditation and reaccreditation activities within the company (corporate, service centers and engagement centers) including the review of documentation prepared for submission.
  • Assist with conducting mock internal readiness audits and file reviews to ensure compliance with accreditation requirements and corporate policies. 
  • Conduct file audits focusing on Case Management (CM), Complex Case Management (CCM) and Utilization Management (UM) standards
  • Prepare written assessment reports of findings of mock audits and file review audits, which include areas for improvement and recommendations.
  • Communicate audit findings and CAP progress and completion to Corporate Quality Committee and Corporate Medical Management Committee
  • Assist with developing national policies and procedures and other key quality documents. 
  • Assist with developing tools to assist with accreditation preparation and status monitoring.
  • Provide technical assistance with delegation oversight audits.  
  • Develop and facilitate staff education with regard to updates of the accreditation standards and strategies to achieve and/or maintain compliance.

Position Requirements:

Education: Master’s Degree in health care related field or RN with relevant QM or Managed Care Experience

Licenses: RN or Masters’ Level Licensed Clinician Preferred

Years and Type of Relevant Work Experience:

  • Licensed Clinician or RN with at least 3 years work experience in one of the following related fields: QM, Psychology, Behavioral Health, Statistics, or relevant QM or Managed Care Experience
  • If Non-licensed, 5 years of health care UM or QM work experience, 1-3 years’ experience in NCQA, and /or URAC accreditation, 2 years managed care experience

Knowledge/Skills/Abilities:

  • Solid knowledge of accreditation standards and processes (NCQA, URAC, etc.)
  • Clinical and/or managerial experience in behavioral health care environment
  • Strong problem solving skills
  • Strong organizational and communications skills
  • Ability to manage multiple priorities
  • Experience in healthcare, behavioral health preferred
  • Prioritizes multiple deliverables within a fast-paced environment so that deadlines are successfully met
  • Verbal/Verbal communication
  • Maintains accuracy and confidentiality
  • Microsoft Office Suite

TO APPLY

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled

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