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Lumeris National Committee for Quality Assurance (NCQA) Accreditation Consultant in St. Louis, Missouri

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Position:

National Committee for Quality Assurance (NCQA) Accreditation Consultant

Position Summary:

Utilizes expertise and prior experience with National Committee for Quality Assurance (NCQA) to help ensure program. Leads accreditation activities, participates as a member of an accreditation task force, provides analysis of NCQA data, and reviews/revises all NCQA policies. Reports to team leadership and will develop cross-functional partnerships with department staff to fulfill NCQA requirements. Specific tasks include translating requirements, analyzing data in order to write NCQA analyses and reports, and supporting departments with revisions to Policies & Procedures for NCQA-compliance.

Job Description:

Primary Responsibilities

  • Leads tasks related to NCQA Health Plan and Utilization Management and Case Management accreditations. Develops and maintains excellent relationships within all levels of the organization, external clients, and external business partners.

  • Collaborates with multiple departments within Lumeris relating to innovation, quality, and process improvement to drive best practice and knowledge sharing in order to achieve NCQA reaccreditation status.

  • Uses existing or develops new NCQA templates to initiate, plan, control, execute, and close NCQA gaps and opportunities.

  • Monitors existing NCQA project and pipeline activity and ensures internal teams are staged to support.

  • Provides updates and education regarding any NCQA accreditation changes to the appropriate work group, committee, council, or leaders.

  • Provides comments regarding NCQA accreditation requirements in conjunction with Compliance regulatory affairs Subject Matter Experts.

  • Reviews policies and procedures to provide feedback regarding NCQA standards compliance.

  • Provides communications to leaders regarding gaps, opportunities, action plans, and performance improvements.

  • Escalates issues to management as needed to keep projects on track or return to established timelines within a reasonable period.

  • Reports on the status of all assigned projects to communicate the overall health of each accreditation.

  • May participate in the NCQA oversight committees.

  • Translates NCQA standards for programs, committee, and operational understanding.

Qualifications

  • Bachelor’s degree required; Master’s degree in Business Administration, Health Administration, Public Health, or other related area of study strongly preferred

  • 8+ years of related experience, including experience with NCQA responsibilities such as leading accreditation activities, participated as member of accreditation task force, provided analysis of NCQA data, or reviewed/revised all NCQA policies

  • Thorough knowledge of project management best practices

  • First-class presentation, written, and verbal communication skills

  • Demonstrated history of quickly building relationships, gaining credibility, influencing, and partnering with business and clinical leaders and peers across the organization

  • Accomplished facilitation experience in complex, high risk, group dynamics including design workshops, facilitating sessions, and working with teams

  • Excellent interpersonal, analytical, problem-solving, facilitation, organizational, prioritization, decision making, and conflict resolution skills

  • Excellent written and verbal communication skills and the ability to communicate/collaborate effectively with all levels of employees, management, executives, providers, and external organizations

Working Conditions

  • While performing the duties of this job, the employee works in normal office working conditions.

Disclaimer

  • The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

Lumeris is an EEO/AA employer M/F/V/D.

Location:

Addison, TX, Addison, TX, Apollo Beach, FL, Arlington, TX, Atlanta, GA, Austin, TX, Baltimore, MD, Barrow, GA, Bartow, FL, Baton Rouge, LA, Boston, MA, Brandon, FL, Braselton, GA, Charlotte, NC, Chicago, IL, Clearwater, FL, Columbus, OH, Dade City, FL, Dallas, TX, Dayton, OH, Denver, CO, Detroit, MI, Durham, NC, Edison, NJ, Fredericksburg, VA {+ 29 more}

Time Type:

Full time

Join Our Growing Team!

Lumeris is a value-based care managed services operator for health systems and providers seeking extraordinary clinical and financial outcomes. Lumeris aligns providers and payers across populations with technologies, processes, behaviors and information to achieve high-quality, cost-effective care with satisfied consumers — and engaged physicians.

Lumeris with Essence Healthcare, its inaugural client and learning laboratory with more than 60,000 Medicare members in Missouri and Illinois, has averaged a CMS rating of 4.5 Stars for the last ten years and produced the highest consumer and physician satisfaction scores in the industry along with significantly better clinical outcomes and lower costs. For more information, go to www.lumeris.com.

Why Join Lumeris?

At Lumeris, you will be part of team that is focused on solving the nation’s healthcare problem, and you will be able to contribute to our purpose. Our environment is fast-paced, change-oriented and focused on growth and employee engagement. At Lumeris, we know that talent is best utilized when given the opportunity to succeed. That is why we have removed the boundaries that inhibit success and focus on fostering an environment that allows employees to utilize their talents.

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