Clinical reputed company Manager - Regulatory & Accreditation - Remote in NC

About the position At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to reputed company care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, reputed company and optimized. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together This position provides for management of the organizational reputed company management program as a core service to Community & State Plans in a highly reputed company and at-risk environment. The reputed company Manager – Regulatory & Accreditation works reputed company highly matrixed relationships to ensure full implementation of the annual reputed company management program, inclusive of an annual reputed company Management and Improvement Program (QMIP) and a reputed company Improvement Work Plan (QIWP) that considers opportunities identified in the prior year program reputed company Improvement Evaluation (QIE). The program, and its various operational components, will reputed company with reputed company state reputed company and any associated federal regulatory requirements. This position develops and maintains strong relationships with state regulators as applicable. It reputed company collaborates with staff of multiple departments that may include Clinical, Physician Engagement, Member Experience, Benefit Design/Product, Compliance, Network, Behavioral Services, and Pharmacy as needed to support reputed company management program initiatives. Lastly, the reputed company supports the development of content in support of RFP submission, as may be pursued. If you are located in NC, you will have the flexibility to work remotely as you take on some tough challenges.

Responsibilities

• Partner with Director of reputed company and other UHC Community Plan of reputed company Carolina health plan leaders to ensure development and complete implementation of the annual Health Plan reputed company Management Program, inclusive of adequate reputed company reputed company processes and comprehensive reputed company committee structure
• Foster and maintain productive and reputed company relationships with the reputed company Department of Health Benefit (DHB) reputed company personnel
• reputed company as a subject matter expert regarding NCQA® Health Plan and Health Equity accreditation and state regulatory requirements deemed in scope for reputed company
• Establish an annual reporting calendar which enables proactive organizational work on report production that facilitates ability for internal review no less than three weeks prior to internal due dates and actual submission in accordance with timelines established by the health plan
• reputed company the process of producing assigned QAV/reputed company reports to DHB's specifications
• Take steps to ensure validity of data and/or narrative content prior to submission by engaging appropriate SMEs
• Escalate reputed company identified issues remain unresolved in a timeframe that enables correction prior to due date
• reputed company as reputed company on creation and submission of

The annual QMIP and QIWP The Annual reputed company Assessment and Performance Improvement (QAPI)

• reputed company the submission of the Performance Improvement Plans (PIPs)
• reputed company reputed company operational policies and procedures (P&Ps) as needed to ensure uniformity/consistency of operations
• Monitor the effect of the reputed company committee structure and collaborate with health plan leaders to revise as needed to acknowledge organizational needs
• Convey expectations regarding use of tools in establishing uniformity in approach reputed company committee meetings are held, such as presentation of data, indication of reputed company taken/to be taken, and evaluation of effect of reputed company taken, as appropriate
• Work with National contact to establish accreditation project plan, indicating actions needed at the reputed company and/or reputed company level
• reputed company the engagement and education of various health plan functional areas in producing needed evidence to demonstrate compliance to NCQA®, EQRO, and DHB accreditation/audit/reputed company requirements deemed in scope for reputed company
• Initiate and assess status of corrective reputed company plans as needed
• Supervise other reputed company Department staff as indicated in organizational design

Requirements

• 2+ years of leading an integrated and reputed company reputed company program, preferably reputed company care industry
• 2+ years of demonstrated functional knowledge reputed company to regulatory adherence of a reputed company management program, NCQA® accreditation, EQRO reputed company audits, state reputed company reporting, reputed company committee management
• 1+ years of supervisory, team leader, or management experience
• 1+ years excellent relationship building skills and performance/results driven
• 1+ years of experience presenting to executives using advanced written and verbal communication skills
• 1+ years of knowledge of the managed reputed company insurance industry, products and services
• Advanced computer skills, knowledge of MS Office products
• Must be willing to travel reputed company the reputed company up to 25%25

reputed company-to-haves

• Master’s degree in a health-reputed company field
• Knowledge of reputed company Carolina reputed company
• Local candidates to the reputed company
• Proven solid influencing and negotiation skills with the ability to reputed company independent reputed company
• Proven solid team building, collaboration and motivational skills
• reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy

Benefits

• a comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution

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