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Director of Accreditation

WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical Center HealthNet Plan, we provide plans and services that work for our members, no matter their circumstances.

Apply now (https://jobs.silkroad.com/BMCHP/Careers/Apply/MultiForm/294315)

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The Director of Accreditation is responsible to attain and maintainNCQAHealth Plan Accreditation and NCQA Health Equity Accreditation. The Director oversees the accreditation and clinical delegation teams. The director, in partnership with the Senior Director of Quality Strategy and Performance, develops and oversees strategies, Policies and processes and a comprehensive road map to ensure ongoing readiness for all accreditations including but not limited to NCQA and DOI. The Director will work closely with cross-functional teams to ensure compliance with NCQA standards, manage team workload and work assignments and provide oversight for NCQA surveys. The Director is responsible for executingthe overall strategic direction, operational oversight, and analysis, regulatory compliance forensuring that delegated First Tier, Downstream and related (FDR) entities maintain compliance with all applicable federal, state and accreditation requirements. They will lead the team that will be the subject matter experts for various accreditation programs, such as National Committee for Quality Assurance (NCQA) and Accountable Care Organizations (ACO), and require expertise in Special Needs Plan (SNP) standards and guidelines set forth by CMS and NCQA and provides leadership regarding escalated issues as they arise. The position is responsible for both NCQA delegation oversight as well as oversight of medical management contractual requirements delegated to the delegated providers. The director collaborates with the Boston Medical Center Health System clinical team to ensure alignment of activities related to delegated medical management and quality contract requirements and adherence to NCQA accreditation requirements.

Our Investment in You:

· Full-time remote work

· Competitive salaries

· Excellent benefits

Key Functions/Responsibilities:

· Leads all Plan activities for National Committee for Quality Assurance (NCQA) re-accreditation.

· Develops and maintains relationships with key contacts at NCQA

· Responsible for the ongoing administrative, clinical, fiscal and programmatic interaction with NCQA. Communicates with NCQA as needed to ensure the Plan is informed of all events and circumstances that affect the initial and on-going achievement of NCQA accreditation.

· Works closely with cross-functional teams to ensure compliance with NCQA

· Develops and maintains roadmap to ensure timely completion of accreditation requirements

· Responsible for ongoing communication with Plan leadership on accreditation progress and any identified areas of improvement or associated risk

· Creates and manages Plan-wide awareness of the value of accreditation and ensures that it is reflected in the company’s ongoing processes and procedures.

· Supports cross-functional efforts to maintain ongoing practices in support of re-accreditation efforts and other quality based projects and initiatives.

· Monitors and ensures compliance with delegated functions across all markets and products.

· Collaborates with the Boston Medical Center Health System clinical team to ensure alignment of activities related to delegated medical management and quality contract requirements and adherence to NCQA accreditation requirements.

Supervision Exercised:

• Directly or indirectly oversees management of clinical and non-clinical staff

Supervision Received:

· General supervision is received weekly.

Qualifications:

· Bachelor’s degree or an equivalent combination of education, training, and experience in related field.

· Minimum five (5) years of experience in Accreditation, with a proven track record of success in NCQA Health Plan Accreditation and/or NCQA Health Equity Accreditation

· Strong understanding of NCQA health plan Accreditation standards and survey administration

· Strong leadership experience, critical thinking/problem solving skills, and a strategic mindset.

Preferred/Desirable:

· Master’s degree in a related field.

· Clinician, certified in nursing or behavior health preferred.

Experience:

· Minimum five (5) years of experience in Accreditation

Preferred/Desirable:

· Demonstrated competence in successful interactions with accrediting bodies.

· Previous project management experience.

Certification or Conditions of Employment:

· Pre-employment background check

Competencies, Skills, and Attributes:

· Ability to facilitate process improvement efforts.

· High proficiency in Microsoft Office including Word, Excel, PowerPoint and Visio.

· Strong ability to foster relationships and build consensus; strong interpersonal skills.

· Ability to lead cross-functional groups, interact will all levels and areas of the organization, and interact with both clinical and non-clinical teams or individuals.

Working Conditions and Physical Effort:

· Regular and reliable attendance is an essential function of the position.

· Work is normally performed in a typical interior/office work environment.

· No or very limited physical effort required. No or very limited exposure to physical risk.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

Apply now (https://jobs.silkroad.com/BMCHP/Careers/Apply/MultiForm/294315)

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