Manager, Accreditation and Delegation
The Manager, Accreditation and Delegation is responsible for the ongoing NCQA accreditation cycles and design, implementation, and continuous quality improvement of all delegated functions within Strive Health’s Chronic Kidney Disease Population Health Program. Oversight of NCQA accredited as well as delegated and sub-delegated activities to ensure compliance primarily with NCQA standards; ensuring internal performance in accordance with all NCQA, state, and federal regulatory and contractual requirements.
Essential Functions:
Serve as subject matter expert in NCQA Accreditation across all modules
Build Market and Enterprise Business relationships to ensure an understanding of all activities/requirements/deliverables
Ensure NCQA updates and impact education are appropriately implemented with key stakeholders
Road map with Market/Corporate Leaders to meet Corporate Goals and Yearly Strategic Plans
Identify and communicate survey status, gaps and escalations to Director of Quality
Partner with market and corporate teams to ensure mitigation plans for identified gaps are implemented
Ensure all work plans and dashboards are updated for reporting
Manage and execute on multiple module activities
Provide oversight and monitoring to all surveys and deliverables
Build, sustain and leverage relationships organization wide when gathering, interpreting and communicating NCQA requirements
Onboard new team members on module and Market specific requirements
Manage escalations to resolution
Manage Survey Submission Process
Facilitate ongoing annual qualitative and quantitative analyses, assuring business owners are taking action on their opportunities for improvement
Ensures the organization is always appraised of all standard changes/updates and implements plans to ensure compliance with changes in a timely manner.
Participate in and support Quality Committee and other applicable committee as required
Ensure Market resources are trained on NCQA activities and deliverables to ensure continuous readiness
Collaborate with the business owners, obtain documents, reports and materials for accreditation submission
Monitor, track and document deliverables related to accreditation process by applying accreditation standard to Strive Health processes and documents in conjunction with the business owners
Acts as advisor to market and business on appropriate documentation and data analysis needs for required improvement opportunities to meet the intent of the NCQA standards
Acquire an in-depth knowledge of the Standards within the scope of work and ensure that changes made by NCQA are communicated and incorporated into business processes
Ensure a strong understanding of the business processes within the scope Market/Standards assigned
Perform a variety of complex work in planning, coordinating, amend and managing accreditation activities
Provides education to staff and business owners on accreditation standards and provide timely updates to affected departments
Review and analyze documents, reports, and materials for submission. Ensures accuracy prior to submission
Provide management recommendations for improvement related to accreditation process and document process improvement
Maintains accreditation spreadsheets for applicable standards
Have a working knowledge of the NCQA Submission process
Work with the Director of Quality to meet Corporate Goals and Yearly Strategic Plans
Manages all aspects of the delegation & sub-delegation process.
Acts as the Liaison between the and the Payor Delegation teams.
Responds to and coordinates activities and responses for pre-delegation and ongoing monitoring requests.
Performs regular chart review / audit and provides subsequent feedback/education to the production team.
Partners with the analytics team on completing population assessments for segmentation.
Minimum Qualifications
Bachelor's Degree in related fields or an equivalent combination of education and experience.
3 - 5 years' related experience ie; quality, compliance, etc.
3- 5 years’ experience in NCQA
3 years’ experience with quality improvement and data analysis
Preferred Qualifications
Ability to teach, strong organizational skills, excellent communication, customer service, relationship development, results orientation, team building and decision-making.
Understanding of Value Based Care
Demonstrated ability, or potential, to excel in smaller entrepreneurial organizations.
Excels at developing strong patient/family relationships that fosters engagement and best outcomes
Experience working with virtual teams
Ability to build strong strategic work relationships and trust.
Excellent verbal, written and meeting presentation skills.
Excellent interpersonal communication and negotiation skills.
Proven ability to continuous Improvement, planning, and organizing.
Proven ability to be a team player