Accreditation Quality and Compliance Specialist II

MedImpact Healthcare Systems Inc.; San Diego (CA); Sur place; USD 69 000 - 119 000; Plein temps

Avantages offerts par ce poste

Medical insurance

PTO and holidays

Incentive compensation

401K with company match

Life and disability insurance

Tuition reimbursement

Employee referral bonus

Résumé du poste

MedImpact Healthcare Systems, Inc. is seeking a qualified professional to drive accreditation readiness across NCQA and URAC programs for Commercial, Medicare, Medicaid, and Marketplace lines.

The role focuses on clinical quality, utilization management, and regulatory compliance. The ideal candidate will coordinate with internal partners and delegated entities, ensuring accurate, timely evidence and documentation while supporting audits and client requests.

Qualifications

• BS/BA and 5+ years’ experience in PBM/Managed Care or equivalent.
• Subject-matter expert in NCQA and URAC standards with audit experience.
• Experience with URAC PBM accreditation and state licensure preferred.

Responsabilités

• Execute annual accreditation, clinical quality, and UR licensure processes.
• Coordinate with internal and client teams to support accreditation activities.
• Prepare reporting and documentation for accreditors and regulators.
• Lead pre-delegation evaluations and monitor delegation oversight.

Connaissances

NCQA URAC standards

Healthcare policy

Microsoft Office

PDF/document tools

Formation

BS/BA in related field

Outils

Microsoft Word

Excel

Outlook

PDF editors

Description du poste

MedImpact Healthcare Systems, Inc. is seeking a qualified professional to drive accreditation readiness across NCQA and URAC programs for Commercial, Medicare, Medicaid, and Marketplace lines.

The role focuses on clinical quality, utilization management, and regulatory compliance. The ideal candidate will coordinate with internal partners and delegated entities, ensuring accurate, timely evidence and documentation while supporting audits and client requests.