Job Summary

​Responsible for the development/implementation of relevant programs and strategic initiatives. Provides direction to Health Plan leadership related to all accreditation/compliance activities. Ensures coordination of all process improvement activities to maintain the highest-level accreditation by the National Committee for Quality Assurance (NCQA) and full compliance with the Center for Medicare and Medicaid Services (CMS), Department of Health (DOH), Department of Insurance (DOI), and Department of Labor (DOL) regulations.

Job Duties

• Supervises Health Plan accreditation operations coordinates and reviews and interprets all standards for regulatory requirements and distributes to appropriate representatives of the Health Plan.
• Leads the assessment and development of current Health Plan needs as they relate to accreditation activities.
• Creates and maintains the Health Plan's QI Plans, Work Plans and Annual Evaluations for GOLD and Commercial lines of business.
• Also creates and maintains the Medical Management plan and Annual Evaluation.
• Reviews past performances, develops action plans for improvement and continued success, and monitors ongoing compliance with the action plans.
• Develops and maintains a record keeping system for accreditation issues.
• Dialogues and strategizes with external accreditation bodies to secure positive outcomes.
• Communicates openly with all Health Plan employees to assure ongoing compliance with regulatory requirements and instill confidence in their ability to meet accreditation requirements in their specific area.
• Leads the assessment of compliance with regulatory body standards on a continuous basis and works closely with all departments to maintain total compliance. Oversees and provides direction to leadership as it relates to accreditation activities.
• Facilitates transfer and receipt of confidential accreditation documentation with external regulatory bodies.
• Provides direction to support staff to assure efficient and effective processes related to ongoing compliance with regulatory body standards.
• Directs pre-delegation visits and oversight activities for all delegated arrangements including assessing the entity's compliance with all applicable standards and regulations to assure all Health Plan regulatory requirements are met.

​Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

Position Details

*Geisinger offers a comprehensive suite of healthcare benefits all starting day one of employment! This includes medical, prescription drug, vision and dental coverage. We also offer up to $5,000 tuition reimbursement and 5% contribution to your retirement plan.

Education

Bachelor's Degree- (Required)

Experience

Minimum of 4 years-Related work experience (Required)

Certification(s) and License(s)

OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.

We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.