Job Description

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.

* Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

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

The Accreditation Manager is responsible for leading and managing accreditation and reaccreditation efforts with organizations such as URAC and NCQA. This role supports Community Health Choices commitment to quality and regulatory compliance by ensuring adherence to applicable standards and driving continuous improvement. The role requires strong knowledge of managed care operations and accreditation standards, particularly in Texas' MCO landscape.

JOB SPECIFICATIONS 

URAC Accreditation Planning & Management 
Lead planning, coordination, and execution of NCQA and URAC accreditation and reaccreditation efforts. Monitor changes in URAC standards and ensure organizational policies and practices remain compliant. Develop educational materials and conduct training sessions for internal departments regarding URAC requirements. 
Accreditation Compliance & Documentation 
Serve as the primary liaison with URAC and internal stakeholders. Lead cross-functional teams to compile, review, and submit documentation for accreditation. Conduct internal audits, gap analyses, and readiness assessments to ensure timely compliance. Develop and track performance metrics aligned with compliance and accreditation goals. 
Stakeholder Collaboration & Reporting 
Partner with internal departments such as Quality Improvement, Compliance, UM, CM, and Customer Service to align procedures with accreditation standards. Prepare reports, dashboards, and presentations for senior leadership and external regulatory agencies. 
Actively contributes to achievement of departmental goals, as identified in Departments annual business plan, including specific departmental process improvement plans and other duties as assigned.

Reports to Position Title: Director, Quality Improvement
Employees Supervised Titles: N/A


QUALIFICATIONS: 

Education/Specialized Training/Licensure: Bachelor's degree in clinical or health care field required.

Masters degree in a health care related field or business strongly preferred.

Work Experience (Years and Area): 5 years progressive experience in health plan operations, quality improvement, or compliance required.

Minimum 3 years experience if master's degree is held required. 

Management Experience (Years and Area): At least 3 years of experience with URAC accreditation processes/standards required. 

Experience with other accreditations, such as NCQA or Joint Commission preferred.

Software Proficiencies: Microsoft Office (Word, Excel, PowerPoint, Outlook) 

Other: 
Strong project management and organizational skills.
Excellent written and verbal communication skills.
Ability to lead cross-functional teams and manage multiple projects simultaneously. 


Job Family/Job Title Competencies
Attention to Detail
Organizational Sensitivity
Critical Thinking
Results Oriented

Application Instructions

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