*Please note, this position allows for remote work throughout the U.S.
Utilizes expertise and prior experience with National Committee for Quality Assurance (NCQA) to help ensure program. Leads accreditation activities, participates as a member of an accreditation task force, provides analysis of NCQA data, and reviews/revises all NCQA policies. Reports to team leadership and will develop cross-functional partnerships with department staff to fulfill NCQA requirements. Specific tasks include translating requirements, analyzing data in order to write NCQA analyses and reports, and supporting departments with revisions to Policies & Procedures for NCQA-compliance.
Leads tasks related to NCQA Health Plan and Utilization Management and Case Management accreditations. Develops and maintains excellent relationships within all levels of the organization, external clients, and external business partners.
Collaborates with multiple departments within Lumeris relating to innovation, quality, and process improvement to drive best practice and knowledge sharing in order to achieve NCQA reaccreditation status.
Uses existing or develops new NCQA templates to initiate, plan, control, execute, and close NCQA gaps and opportunities.
Monitors existing NCQA project and pipeline activity and ensures internal teams are staged to support.
Provides updates and education regarding any NCQA accreditation changes to the appropriate work group, committee, council, or leaders.
Provides comments regarding NCQA accreditation requirements in conjunction with Compliance regulatory affairs Subject Matter Experts.
Reviews policies and procedures to provide feedback regarding NCQA standards compliance.
Provides communications to leaders regarding gaps, opportunities, action plans, and performance improvements.
Escalates issues to management as needed to keep projects on track or return to established timelines within a reasonable period.
Reports on the status of all assigned projects to communicate the overall health of each accreditation.
May participate in the NCQA oversight committees.
Translates NCQA standards for programs, committee, and operational understanding.
Bachelor’s degree required; Master’s degree in Business Administration, Health Administration, Public Health, or other related area of study strongly preferred
8+ years of related experience, including experience with NCQA responsibilities such as leading accreditation activities, participated as member of accreditation task force, provided analysis of NCQA data, or reviewed/revised all NCQA policies
Thorough knowledge of project management best practices
First-class presentation, written, and verbal communication skills
Demonstrated history of quickly building relationships, gaining credibility, influencing, and partnering with business and clinical leaders and peers across the organization
Accomplished facilitation experience in complex, high risk, group dynamics including design workshops, facilitating sessions, and working with teams
Excellent written and verbal communication skills and the ability to communicate/collaborate effectively with all levels of employees, management, executives, providers, and external organizations
Internal Number: R0004237
At Lumeris, we owe our success to our visionary people, all dedicated to the same mission: transforming healthcare, and having a great time while doing it. If you have a passion for healthcare, problem solving and enriching people’s lives through technology, we may have an opportunity for you.