Accreditation Specialist II

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
 

Accreditation experience

One year of Medicaid/state health plans experience

Familiarity with

• NCQA Health Equity Accreditation (HEA) 
• Health Equity Accreditation Plus (HEA+) 
• Experience with State Medicaid Withhold Programs 
• NCQA Health Equity Accreditation (HEA) 
• Health Equity Accreditation Plus (HEA+) 

Position Purpose: Serves as a SME regarding accreditation standards and continuous quality improvement principles. Coordinates and performs accreditation oversight and survey readiness.

• Leads quality improvement activities by coordinating and performing activities related to the scheduled surveys for accreditation readiness
• Develops accreditation activities including but not limited to policies, procedures, workflows, and templates for assigned standards within their market portfolio in collaboration with corporate and market business partners
• Acts as a subject matter expert and provide education/guidance to direct development of compliant processes, projects, and monitoring of performance on accreditation standards to primary business owners
• Ensures consistency of accreditation standards interpretation and process implementation
• Creates, reviews, and finalizes projects with associated documents to ensure they meet quality standards and accreditation requirements in coordination with the markets and corporate
• Prepares final survey submission documents validating for quality and accuracy including content compliance with accreditation and annotating and bookmarking standards
• Initiates appropriate criteria-based accreditation reviews, follow-up, and sustainment to ensure compliance with standards, directives, or regulations.
• Identifies, documents, and assesses compliance risks and works collaboratively with key functions across the organization to drive organizational change to improve quality and ensure compliance with the accrediting body (i.e., NCQA)
• Serves as the primary point of contact for accreditation and regulatory activities. Responsible for tracking, reporting, and ensuring the completion of action items resulting from internal and external assessments / findings related to accreditation
• Communicates with multi-level stakeholders, providing guidance to reduce risk within the organization and collaborates with senior management to identify risk issues and address appropriately as needed
• Analyzes data and implements action for the purpose of improving accreditation management at the service and facility level

Education/Experience:

Bachelor’s degree in Business, related field or equivalent experience.

4+ years of related quality and process improvement, operational experience in applicable business area, HEDIS and/or NCQA experience.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.  Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act