Accreditation Specialist - Community Health Choice
Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
Skills / Requirements
JOB SUMMARY: Responsible for working cross-functionally to support the organization in obtaining and maintaining NCQA Health Plan accreditation. This position uses knowledge of current NCQA Health Plan standards to work effectively with business owners to identify gaps and deficiencies between current processes and the requirements of accreditation standards and to assist in implementation of any necessary changes.
- Education/Specialized Training/Licensure: Bachelor's Degree in Business, Social Work, Health Care, Project Management or related field required. Master's degree preferred
- Work Experience (Years and Area): 3 years of managed care with proven experience with NCQA Health Plan standards. Quality Improvement or Project Management experience is preferred
- Software Operated: Microsoft Office (Word, Excel, PowerPoint, Outlook) Visio, Adobe Pro, Proficient with Zoom and Microsoft Teams
- Other Requirements:
- Must be able to establish and maintain collaborative working relationships across the organization to meet accreditation standards
- Able to communicate with business owners in ways to gain buy-in and support meeting accreditation standards.
- Able to effectively and efficiently keep management updated and able to identify barriers and risks related to accreditation.
- Proficient in annotating and uploading documents to the NCQA portal.
SPECIAL REQUIREMENTS: (Check Applicable Areas)
1. Communication Skills:
Above Average Verbal (Heavy Public Contact)
Writing /Composing: Correspondence / Reports
2. Other Skills: Research, MS Word, MS Excel
3. Advanced Education:
Bachelor's Degree Major: Bachelor's Degree in Business (BA), Social Work, Health Care, Project Management or related field required
Master's Degree Major: MBA or MPH preferred
4. Work Schedule: Flexible
RESPONSIBLE TO: Director