Accreditation & Delegation Oversight Coordinator, Phoenix, AZ
Job Title Accreditation & Delegation Oversight Coordinator (experience with URAC/NCQA accreditation required)
Job ID 4867
Full/Part Time Full-Time
Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,400 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.
Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
Develops, implements and oversees an organization wide Accreditation Plan resulting in successful attainment of Accreditation. Develops and directs accreditation preparation activities and accrediting body reviews. Develops and executes an organization wide quality management program that meets NCQA/URAC accreditation and regulatory compliance requirements. Oversees an organization-wide Delegation oversight plan.
- Develop and implement an Accreditation Program to include development of detail work plans, setting deadlines, coordinating tasks, organization wide training and preparation for accreditation surveys, ongoing readiness activities and monitoring/summarizing accreditation status and activities.
- Coordinate and oversee accreditation and regulatory activities to ensure integration and cohesion throughout accredited divisions
- Responsible for the delivery of accreditation, delegation oversight and quality management deliverables related to standard requirements within defined timeframes
- Act as resource to staff and other departments in the area of accreditation, delegation oversight and quality improvement
- Coordinate and submit applications, attestations, and required accreditation documents to the accrediting body
- Act as single point of contact between the Plan and the accrediting body
- Coordinate and lead accreditation reviews and function as the liaison between the organization and the accrediting body
- Train staff on the use of processes and tools to assess compliance with accreditation standards
- Maintain an ongoing accreditation readiness assessment program which includes maintenance of a detailed workplan
- Participate on internal, external and Association workgroups and teams as needed
- Maintain a Quality Management Program, to include a Quality Management Program Description, Quality Management Work Plan and Annual Program Evaluation
- Conducts analysis including root-cause analysis in partnership with business leads/units when opportunities for improvement identified and develops action plans to close gaps.
- Ensure compliance with the Affordable Care Act Quality Regulations related to Accreditation, Quality Improvement Strategy and Qualified Health Plan Application
- Develop and coordinate the Quality Management Committee (QMC) activities.
- Assist Health Quality Assurance Clinical Leadership with oversight of the monitoring and analysis of outcomes to ensure goals, objectives, accreditation, and regulatory requirements met, and quality improvement activities are effective.
- Prepare and deliver Executive Summary reports to the BCBSAZ leadership, Quality Management Committee and the Board of Directors describing key findings and detailing opportunities for improvements.
- Organization’s Lead and Coordinator of URAC/NCQA Delegation
- Establishes mechanism to assess and document delegate’s compliance with standards and requirements. Oversees the establishment of correction action plans for non-compliance.
- Schedule, coordinate, and Chair the Delegation Committee, including documentation of minutes, keeping the evidence documents and the Delegation SharePoint content current.
- Function as the Organization Lead for the accreditation standards relating to delegation.
- Interface with the Legal Department and internal stakeholders to coordinate pre-assessment activities for potential delegates to ensure accreditation standards met.
- Provide education, guidance, and assistance on quality management/performance improvement principles, tools, and processes.
- Maintain effective working relationships to ensure teamwork in achieving corporate goals.
- Foster good communication with staff by setting clear directives, objectives and providing exchange of ideas
- Provide leadership and oversight on proper change management principles to ensure they maximize benefit and alleviate unnecessary disruption.
- Identify opportunities to achieve administrative efficiencies while maintaining service.
- Establish goals in accordance with overall BCBSAZ objectives and divisional strategic planning
- Participate in strategic planning activities and contribute to departmental and cross-functional teams to achieve BCBSAZ’s future success.
- Ensure the existence of documented department policies and procedures.
- Coordinate activities between multiple divisions to achieve desired results.
- Volunteer within the community to help BCBSAZ give back to community charitable efforts.
- The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
- Ability to travel up to 25% of time to attend work related business meetings, trainings and conferences.
- Perform other duties as assigned.
Required Work Experience
- 3-5 years of experience in the application of managed care practices
- 3-5 years of organization–wide accreditation experience with URAC and NCQA or equivalent; includes performing readiness assessments
- 3-5 years of experience with documentation of quality processes, outcomes and completing Accreditation/Delegation Oversight activity reports
- 3-5 years of delegation oversight includes performing pre-delegate assessment(s) and annual delegation oversight audits
- Bachelor’s degree in a Health Services related field or any combination of education and experience, which would provide an equivalent background
Preferred Work Experience
- 5 years of experience in providing leadership or held an influential role within a medical/health management division of a health insurance organization
- 3 years of vendor management or oversight experience
- Active and unrestricted license to practice as a registered nurse (RN) in the state of Arizona and/or compact state license
- Certified Specialist in Healthcare Accreditation (CSHA)
- Certifed Professional in Healthcare Quality (CPHQ)
Required Job Skills
- Excellent organizational skills and strong attention to detail
- Possess proficient computer and technological skills especially Word, Excel, PowerPoint, SharePoint and Internet
- Ability to gather, analyze data and prepare informative and accurate reports on program progress
- Strong written and verbal communications.
- Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones.
Required Professional Competencies
- Demonstrates ability to interpret accreditation standards, identify organizational gaps, and recommends and supports the implementation of processes to meet standard and/or close gaps
- Ability to develop, organize, motivate, coordinate and collaborate effectively with stakeholders from multiple business areas across the organization
- Interpersonal skills that allow for harmonious relationships with providers, members and coworkers
- Ability to successfully function in an environment characterized by risk taking, rapidly changing market conditions, strong competition and restructuring.
- Proven knowledge of medical care delivery systems, quality management, benefit interpretation, provider relationships, and member services.
- Comprehensive knowledge of credentialing, URAC, NCQA, HEDIS, CAHPS, medical policy issues, and utilization management.
- Strong understanding of the costs/quality challenges of today’s health care environment.
- Ability to identify key strategic performance measures for success
Required Leadership Experience and Competencies
- The capacity, maturity, stature, and communication skills to assume a leadership role in a progressive, growing, and changing organization.
- Ability to work with business unit managers in a partnership setting.
BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.