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Senior Accreditation Specialist
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Job Description
- Req#: SENIO002337
Employer Industry: Behavioral Health
Why consider this job opportunity:
- Salary range between $77,000 - $87,000, plus an annual performance-based discretionary incentive
- Health insurance with $0 premium for employee-only coverage in the core program for those participating in the Wellbeing Incentive Program
- 401(k) with competitive employer match and company-paid life and disability insurance
- Opportunities for professional development and tuition reimbursement
- Paid time off, including paid time off for volunteering
- Meaningful growth opportunities, welcoming and valuing unique backgrounds and experiences
What to Expect (Job Responsibilities):
- Ensure compliance with accreditation standards (NCQA, URAC) and regulatory requirements through audits and policy updates
- Monitor utilization management (UM) and case management (CM) activities, analyzing data and reporting key performance indicators
- Collaborate with clinical and administrative teams to enhance operations and implement evidence-based guidelines
- Educate and train staff on accreditation requirements and best practices for compliance
- Maintain comprehensive documentation and develop action plans to address compliance gaps
What is Required (Qualifications):
- Bachelor's degree in healthcare administration, nursing, or a related field
- Active clinical license (RN, LCSW, LPC, etc.)
- 5+ years of experience in case management, utilization review, or auditing
- 3+ years of experience in a managed care environment
- Experience with NCQA, URAC, CMS, or Joint Commission accreditation standards
How to Stand Out (Preferred Qualifications):
- Master's Degree
- Certified Case Manager or Certified Professional in Healthcare Quality (CPHQ)
- Knowledge of Medicaid and Medicare
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