A leading Healthcare provider in the Pacific Northwest is seeking a Quality Compliance Program Administrator with NCQA Accreditation. As a Compliance Program Administrator for the Quality and Risk Adjustment team, you will acts as an internal consultant for compliance and regulatory issues for facility. You will plan and implement activities needed for a successful accreditation experience. In addition, you will provide strategic project management services to facility Leadership to improve business processes and ensure regulatory compliance.
As a Compliance Program Administrator for the Quality and Risk Adjustment team, you will acts as an internal consultant for compliance and regulatory issues for facility. You will plan and implement activities needed for a successful accreditation experience. In addition, you will provide strategic project management services to facility Leadership to improve business processes and ensure regulatory compliance.
Provide compliance expertise in the form of interpretation, recommendations and education to facility leadership and staff in the areas of accreditation (URAC, NCQA,) and regulatory requirements (e.g. ERISA, HIPAA, PBR, OIC). Interprets standards and determine how the Health Plan will meet standards. Develop and implement work Plans that address actions needed to meet standards, communication plans in order to help ensure successful accreditation. Create applications and reports needed to apply for accreditation or reaccreditation process, designs, plans and training materials, and provides training related to compliance/accreditation activities. Provides oversight of Processes to ensure that facility is meeting compliance and regulatory requirements through completion of regularly scheduled audits (e.g. appeal audits, privacy audits), developing training and tools for collecting, analyzing and synthesizing data applicable to quality and compliance activities. Uses project management skills to provide strategic project management services to leaders and to improve business processes and ensure regulatory compliance through internal policy, process, program and technical changes. Maintains organized and effective documentation of all program activities Identifies trends and patterns that may be targeted opportunities for improvement. Presents findings and recommendations of quality and compliance efforts to appropriate management within Care Facilitation. Ensures delegation compliance of Business Associates delegated for Care Facilitation programs, such as Utilization Management, case management or Disease Management. Include pre-delegation assessment, annual review, and corrective action oversight.
Bachelor's degree in health related field or four (4) years work experience. Certified Professional in Healthcare Quality (CPHQ) is preferred. Demonstrated experience implementing cross-functional projects is preferred
Competitive Benefits Package PAY: 80 - 120K Annually DIRECT HIRE
For IMMEDIATE consideration please respond with resume to Savannah@provisional.com!
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