Virginia Premier Health Plan Accreditation Consultant 1 in Glen Allen, Virginia
Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
If this sounds like you, read on!
The Quality Accreditation Consultant 1 core function includes assisting with ongoing organization-wide regulatory and accreditation readiness. Core functions also include full responsibility for all quality related activities to include, but not limited to, accreditation and regulatory efforts associated with or required by the National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS), a registered trademark of NCQA, the Department of Medical Assistance Services (DMAS), the Centers for Medicare and Medicaid Services (CMS) and other required entities associated with or required by the State and/or Federal Government. The Quality Accreditation Consultant 1 shall be responsible for performing file audits, maintaining interdepartmental communication and education related to expected quality standards and serving as a liaison for regulatory and accreditation quality standard requirements. This position will support the Patient Centered Medical Home (PCHM) Operations. Travel is mandatory.
Lead accreditation and/or regulatory work teams for departments throughout the organization to ensure ongoing compliance.
Support processes to ensure timely and accurate regulatory reporting.Ensure ongoing compliance to accreditation and/or regulatory standards through auditing, assessment, data collection, tracking, monitoring, analysis and feedback/recommendations on improvements.
Implement activities, interventions, and/or deliverables as defined in the work plans, project plans or other format for departments throughout the organization.
Assist with or conduct departmental and file audits, as required, and prepare professional, timely audit reports to include outcomes with meaningful recommendations for improvement.
Ensures P&P’s are current, evidenced based and meet current standards.
Conduct internal (e.g., departmental and organizational) and external educational orientations related to quality standards and compliance.
Utilize effective communication with internal customers/departments and external customers to accomplish accreditation and/or regulatory goals.
Assures policies/procedures compliance to regulatory and accreditation requirements.
Continuously identify streamlining opportunities related to the regulatory and accreditation auditing processes to customer and organization-wide customer satisfaction.
Support programs related to regulatory surveys, such as CAHPS, HCBS, and Member Satisfaction Surveys.
Assists with training, in-services and quality audits as a result of plan, regulatory or accreditation requirements.
Assists with any/other project management duties, as needed.
Maintains current knowledge of Virginia Premier policies and procedures.
Participates in continuing education activities, as appropriate.
M INIMUM EDUCATION REQUIREMENTS
Bachelor’s Degree in Business, Public or Health Care Administration accepted.
Registered Nurse with valid licensure and/or relevant accreditation experience (Preferred).
S P ECIAL KNOWLEDGE AND/OR SKILLS
One to two years of NCQA experience at a managed care level (highly preferred)
Proficient in the use of Microsoft Office Suite, Database management, or Project Management
Excellent verbal and written communication skills, plus strong organizational skills
Ability to plan, prioritize and multitask, while maintaining attention to detail
Strong problem solving skills in a fast paced environment
Effective group facilitation abilities
Ability to interact with varying levels of staff
Ability to interact with providers and enrollees
Ability to adapt to changing priorities
Demonstrate positive interpersonal skills
Must be able to travel
Prior accreditation and/or regulatory experience, especially related to ensuring compliance with state and federal regulations.
Proven experience with interpreting standards and compliance (preferred).
Project management skills/experience (preferred).
Six Sigma training preferred.
All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE
Our mission is to inspire healthy living within the communities we serve!
Job ID 2018-5415
As an equal opportunity employer, Virginia Premier is committed to a diverse workforce. To ensure non-discrimination and affirmative action for individuals protected by Executive Order 11246, as amended, Section 503 of the Rehabilitation Act of 1973, as amended, the Vietnam Veterans’ Readjustment Act of 1974, as amended, and Title I of the Americans with Disabilities Act of 1990, as amended, Virginia Premier will consider applicants for employment without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. Applicants who require accommodation in the job application process may contact Recruitment at 804-819-5151 for assistance. It is the policy of Virginia Premier Health Plan, Inc., to comply with the requirements of the Drug-Free Workplace Act of 1988. It is a violation of our drug-free workplace policy to use, possess, sell, trade, and/or offer for sale alcohol, illegal drugs or intoxicants in our workplace. Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. Virginia Premier participates in E-verify.