Accreditation Specialist

About the role

Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. We believe patients living with kidney disease deserve the best care. We are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants. We help nephrologists focus on the right patients at the right time across the full care spectrum. We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical insight and tools, and services to patients. We listen to the needs of our patients, our employees, and our client partners, continually working to push beyond the status quo in which the care system manages patients today.

Requirements

• Your Role
• Primary Functions
• Collaborate with internal partners to collect data and develop compliance documents/evidence for successful accreditation surveys
• Monitor and maintain comprehensive compliance documents and evidence to ensure successful accreditation survey and ensure adherence to NCQA standards
• Maintain up-to-date records.
• Educate staff across the organization regarding accreditation standards and requirements
• Evaluate current practices and identify compliance gaps and recommend solutions to close gaps
• Prepare training materials, reports, and materials to support compliance
• Coordinate accreditation surveys and serve as a point of contact during surveys to ensure all requirements are met
• Act as subject matter expert, handling complex assignments, and may assist training/mentoring department staff
• Regular and reliable attendance
• Other duties consistent with this role, as assigned.
• Required Qualifications
• Bachelor's degree and 4 years of experience in managed care environment OR 6 years of work experience in managed care environment
• Managed care environment experience includes one or more of the following areas: audit, health plan operations, compliance or legal
• 2 years Accreditation experience (i.e. NCQA, URAC, Joint Commission, CMS) to include managing survey/review experience
• In-depth knowledge of NCQA standards and accreditation processes
• Knowledge of health care regulatory and legislative process; experience reading and interpreting legislation
• Experience using Total Quality Management (TQM) / Continuous Quality Improvement (CQI) concepts
• Knowledge or experience reviewing accreditation standards and evaluating level of compliance, identifying challenges and proposing solutions
• Knowledge or experience monitoring compliance and managing evidence documents
• Verbal and written communications skills including training skills
• Research and analytical skills
• Experience managing multiple complex priorities, often with limited time frames
• Detail oriented with strong organizational skills and experience meeting deadlines
• Intermediate skills with MS Office Suite of products including Outlook and Teams
• Able to work effectively in a primarily remote environment:
• Home internet must support a minimum download speed of 25 Mbps and upload speed of 10 Mbps. Cable, Fiber, or DSL connections hardwired to the internet device are recommended
• Evergreen will provide remote employees with telephony applications and equipment to meet the business requirements for their role
• Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• Project Management (PMP) certification
• Ability to think critically and suggest innovative solutions

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