We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, *WA, WI & WY only).
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!
Job Summary
Responsible for the oversight, development, implementation, education and maintenance of the URAC accreditation process for all TriWest accreditation programs. This accreditation program demonstrates the organization’s commitment to upholding and improving outcomes for our beneficiaries throughout the healthcare continuum. This individual will have a broad knowledge of the regulatory and accreditation landscape and function as a subject matter expert to ensure alignment and continued adherence to URAC standards across all programs.
Education & Experience
Required:
• Bachelor’s degree in Business, Health Care Administration or related field or equivalent education and experience (I.E. Associate Degree with 5+ years of accreditation support experience)
• Minimum of 3 years of Accreditation support experience (URAC, NCQA, CMS) in a Managed Care Organization (MCO) or healthcare system
• Demonstrated experience managing and facilitating onsite and virtual audits and surveys
• Demonstrated experience in reading and interpreting regulatory, accreditation and contractual standards.
Preferred:
• Project Management experience and/or certification strongly preferred
• Experience in data management, analytics and report building
• Experience in program and outcome assessments
Key Responsibilities
• Act as a URAC subject matter expert for accredited business units and the company leadership team.
• Plan, develop, design and implement tools, process and policy compliant with accreditation and regulatory standards.
• Monitoring and maintenance of data and metrics as compliance evidence.
• Educating staff across the organization regarding URAC Accreditation standards and requirements.
• Evaluating current practices; identifying compliance gaps and recommending solutions to close gaps.
• Actively lead URAC accreditations onsite visits and desktop reviews.
• Monitor regulatory agencies and standards for changes and updates.
• Interpret standards and collaborate with operational leadership to translate into operational workflow and tools.
• Assist with the development of training materials and reference materials to support URAC compliance.
• Identify accreditation/regulatory compliance improvement opportunities and collaborate with leadership on creating action plans to address.
• Design, develop and maintain accreditation and survey readiness plan and tools to ensure requirements and standards are always met.
• Defines and tracks necessary reports and metrics reflecting stability as relates to accreditation and regulatory compliance survey readiness.
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Competencies
Commitment to Task: Ability to conform to established policies and procedures; exhibit high motivation.
Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.
Computer Literacy: Ability to function in a multi-system Microsoft suite of applications, TriWest Intranet, the Internet, and department software applications.
Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.
Empathy / Customer Service: Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position.
Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.
High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.
Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.
Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.
Technical Skills: Knowledge of TRICARE programs and benefits, Managed Care concepts, and healthcare principles and delivery systems, URAC utilization, case and disease management standards; utilization, case and disease management interventions, collaboration skills, legal and regulatory requirements, HIPAA privacy regulations, and proficient with Microsoft suite of applications.
Working Conditions
Working Conditions:
• Regular and reliable attendance
• Availability to work non-regular hours as needed
• Ability to travel as needed
• Extensive computer work with prolonged periods of sitting