Virginia Premier Health Plan Manager, Accreditation Medicare in Glen Allen, Virginia

About Us

Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.

By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.

At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.

If this sounds like you, read on!

Overview

The Accreditation Manager will support the Director of Quality (Medallion) and Accreditation, the Quality Improvement Department in all quality (e.g., accreditation and regulatory) related activities, in multi-states, to include, but not limited to efforts associated with or required by the National Committee for Quality Assurance (i.e. NCQA), Healthcare Effectiveness Data and Information Set (i.e. HEDIS), a registered trademark of NCQA, the Centers for Medicare and Medicaid Services (i.e. CMS) and other required entities associated with or required by the State and/or Federal Government. Assists in the oversight and management of Quality Improvement initiatives. This position is responsible for the Medicare Advantage and Prescription Drug plan (MAPD) line of business. Travel is mandatory.

Responsibilities

  • Assist the Director of Quality and Accreditation with development of policies and procedures for use in implementation of new and existing accreditation and regulatory requirements.

  • Collaborates on annual projects as requested including, but not limited to HEDIS, NCQA and MCO site reviews.

  • Leads and works with the team and organization on special audits and studies, designing forms, tracking data, conducting departmental and organizational quality education, analyzing data and other related tasks.

  • Manages staff and assigned projects with minimal supervision, including personnel management, data entry and initial data analysis at the direction of management.

  • Uses effective communication with various internal departments and external customers to accomplish goals of the department.

  • Ensures ongoing compliance with state, federal, HEDIS (Effectiveness of Care Measures) and accreditation reporting requirements.

  • Participates in other related duties as assigned.

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Bachelor’s Degree, preferred (e.g., Project Management, Business, Public Admin./Health, Health Care Admin. or any health related field)

  • Quality certification, preferred

  • Management experience highly preferred (1-3 years minimum)

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Excellent verbal and written communication skills, plus strong organizational skills with the ability to plan, prioritize and multi-task required.

  • Project management experience required (1-3 years).

  • One year of solid accreditation related experience required.

WORK BACKGROUND/EXPERIENCE

  • Prior quality (e.g. accreditation and/or regulatory) experience, especially related to ensuring compliance with state, federal and accreditation regulations and/or standards is preferred

  • Proven experience with NCQA (or other comparable entity) related to the interpretation and compliance of standards

PHYSICAL REQUIREMENTS

  • Physicalhealth sufficient to meet the ergonomic standards and demands of the position

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

Our mission is to inspire healthy living within the communities we serve!

Job ID 2018-4954

As an equal opportunity employer, Virginia Premier is committed to a diverse workforce. To ensure non-discrimination and affirmative action for individuals protected by Executive Order 11246, as amended, Section 503 of the Rehabilitation Act of 1973, as amended, the Vietnam Veterans’ Readjustment Act of 1974, as amended, and Title I of the Americans with Disabilities Act of 1990, as amended, Virginia Premier will consider applicants for employment without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. Applicants who require accommodation in the job application process may contact Recruitment at 804-819-5151 for assistance. It is the policy of Virginia Premier Health Plan, Inc., to comply with the requirements of the Drug-Free Workplace Act of 1988. It is a violation of our drug-free workplace policy to use, possess, sell, trade, and/or offer for sale alcohol, illegal drugs or intoxicants in our workplace. Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. Virginia Premier participates in E-verify.