Accreditation Specialist Jefferson Health Plan

Job Details

Job Description

• Interface with internal and external clients committees and departments in the review of data and in the implementation of appropriate interventions to effect improvement.
• Assist key Health Partners Plans business units with understanding the NCQA standards.
• Collect and prepare the documents for survey submission; annotate bookmark.
• Assist with Health Outcomes Survey (3 year cycle)
• Assist with Health Plan Survey - Medicaid (3 year cycle)
• Assist with Health Plan Survey - Exchanges PPO (3 year cycle)
• Assist with Health Plan Survey - Exchanges HMO (3 year cycle)
• Assist with LTSS Survey (3 year cycle)
• Participate in Report template creation and updates
• Crosswalk of policy and standard changes
• Assist with Workplan Updates
• Serve as subject matter expert regarding evaluating interpreting and summarizing NCQA standards Accreditation requirements report writing and policies and procedures
• Assist with Mock File Review training and communication needs
• Identify gaps in evidence and compliance
• Participate in Accreditation Committee Meetings
• Perform other duties as assigned.

Education and Experience:

• Bachelors Degree Healthcare or Business Required
• Masters Degree Healthcare or Business Preferred
• 3 years NCQA Experience Compliance Audit experience and2 years Managed Care Experience required
• No less than 1 year of successful NCQA Accreditation process completion and continuous process improvement experience preferred

Work Shift

Worker Sub Type

Employee Entity

Primary Location Address

Nationally ranked Jefferson which is principally located in the greater Philadelphia region Lehigh Valley and Northeastern Pennsylvania and southern New Jersey is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65000 people strong dedicated to providing the highest-quality compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrows professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic clinical and applied research. Thomas Jefferson University home of Sidney Kimmel Medical College Jefferson College of Nursing and the Kanbar College of Design Engineering and Commerce dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8300 students. Jefferson Health nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age race color religion creed sexual orientation gender gender identity marital status pregnancy national origin ancestry citizenship military status veteran status handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues including medical (including prescription) supplemental insurance dental vision life and AD&D insurance short- and long-term disability flexible spending accounts retirement plans tuition assistance as well as voluntary benefits which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues including those who work less than part-time(including per diemcolleagues adjunct faculty and Jeff Temps) have access to medical (including prescription) insurance.

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