Enterprise Accredidation Program Manager
Your career starts now. We’re looking for the next generation of health care leaders.
At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com.
Role Overview
Reporting to the Director, Quality Operations, the Enterprise Accreditation Programs Manager has corporate responsibility for accreditation for all Medicaid, Medicare, Exchange, and Long Term Services and Support plans. In addition to supporting the NCQA activities for the enterprise related to utilization management, behavioral health, population health, network management or delegation requirements this position will ensure policy standardization and implementation for the health services organization. Work Arrangement- Remote role
- Monday through Friday, 8:00 AM EST to 5:00 PM EST
- 30% to 40% travel required across the enterprise footprint during on-site audits
- Participate in the development and management of the strategy to support health plan accreditation across the enterprise.
- Serves as the enterprise-wide professional expert and liaison for accreditation related to one or more of the following subject matter areas: utilization management, behavioral health, population health, network management or delegation requirements within the standards.
- Oversight of new and existing standards to ensure compliance to NCQA standards across all impacted subject matter or functional areas; support the design, implementation, and ongoing monitoring of policies, systems, and processes required to remain compliant.
- Monitors performance against requirements and ensures compliance through continual review, audit and monitoring.
- Collaborates with business owners to establish, implement, develop, and execute best practices to support accreditation (health plan and multicultural).
- Implements opportunities for process improvement that impact accreditation across organizational lines of business.
- Maintains knowledge of company policies and procedures to ensure compliance and support of standards in all levels of government (Local, State & Federal).
Education and Experience
- Bachelor's Degree required.
- RN, MSW or Licensed Behavioral Health professional preferred
- Previous experience leading utilization management, behavioral health services or population health preferred
- Experience with NCQA standards, submissions and on-site reviews.
- Medicaid and Medicare experience preferred.
- Strong written and oral communication skills required.
- Proficient in Microsoft Word, Excel and PPT.
- Experience with compliance programs and/or policy development preferred.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
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