Gateway Health Plan
Job Description :
The incumbent conducts all NCQA accreditation and regulatory requirement activities including ongoing compliance monitoring, submission of NCQA, DE survey materials, coordination of NCQA site visits, NCQA notification of any material changes to the contract, and assessments to determine potential delegation under NCQA standards. The incumbent and their team, along with other staff members having experience with process improvement methodologies, look for ways to continuously improve processes that positively impact quality outcomes. The incumbent ensures timely and accurate monthly, quarterly annual reporting to regulatory authorities regarding the quality program as defined by the applicable state reporting regulations. The incumbent effectively manages all NCQA delegated functions including delegation agreements, pre-delegation assessments, ongoing monitoring and annual assessments.
- Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
- Ensure compliance with NCQA, EQRO and CAP initiatives. .
- Responsible for Coordination, completion, and analysis of department audit process
- Training and education for care coordination staff
- Other duties as assigned.
- Bachelor’s Degree in Health Care
- 6 years of experience in an accredited and/or regulatory position
- BSN, MSN or MSW preferred
- 3 years Accredited and/or Regulatory role
- 3 years Management/Supervisor role or experience leading/working on project teams
- Strong experience as a trainer
- Experience leading quality initiatives including NCQA, EQRO, CAP (Corrective Action Plans), etc.
LICENSES or CERTIFICATIONS
- Current and valid license in Delaware – acceptable licensing includes one of the following:
- Registered Nurse (RN)
- Licensed Clinical Social Worker (LCSW)
- Lean / Six Sigma
- Superior verbal and written communication skills
- Superior leadership skills
- Working knowledge of MS Office products
- Strong critical and strategic thinking skills
- Superior organizational and task management skills
- Ability to collaborate effectively across teams
- Ability to work in a high performing team environment that requires flexibility
- Incumbent must reside in Delaware or the greater Philadelphia area, commutable distance to the office
Language: (Other than English)
0% – 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
TEACHES / TRAINS OTHERS REGULARLY
Travel regularly from the office to various work sites or from site-to-site
Employee Referral Level: 3
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