Health Plan Accreditation Specialist

McLaren Health Care; Flint (MI); On-site; USD 55,000 - 75,000; Full time

Job summary

McLaren Health Plan is seeking a National Committee for Quality Assurance Specialist to advance the organization's quality program. The role coordinates quality improvement activities, supports committee functions, and ensures NCQA standards and HEDIS requirements are met across departments.

Ideal candidates bring strong knowledge of NCQA standards, quality management experience, and the ability to lead audits and data analyses to drive continuous improvement for Michigan's health plan members.

Qualifications

• Associate degree in health care field or equivalent experience.
• Four years' experience with a government regulated health organization or a managed care setting, including experience with quality management activities such as HEDIS and NCQA.

Responsibilities

• Accountable for assigned NCQA standards and oversight of delegated activities.
• Collaborates with Plan departments to ensure NCQA standards are met and documentation is maintained.
• Counsels and guides Plan employees on accreditation standards and quality initiatives.
• Supports committee functions, ensuring meetings are organized and well documented.
• Leads quality projects and audits as directed and manages related state requirements.
• Assumes project management responsibilities as directed.

Skills

Quality improvement

Data analysis

NCQA standards

HEDIS

Education

Associate degree in healthcare

Bachelor's in healthcare

Job description

McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a National Committee for Quality Assurance Specialist to join in leading the organization forward.

MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA).

MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org

Position Summary

The NCQA Specialist coordinates quality improvement activities and supports various functions within the scope of the Plan quality improvement program, working both independently and as a team member. The functions may include but are not limited to committee support; regulatory and accreditation standard adherence; delegation oversight; performance monitoring and assessment; data collection and analysis; and the continual advancement of the quality improvement process to achieve the Health Plan's goals of excellence.

Essential Functions and Responsibilities

• Accountable for assigned standards from National Committee for Quality Assurance (NCQA), which may involve oversight of delegated activities.


• Works with Plan departments, such as Quality, Contracting, Provider Relations, Member Services, Appeals and Grievances, Pharmacy Services, Utilization and Medical Management, Credentialing, and other departments and delegates to ensure that NCQA standards are met, and appropriate documentation is maintained.


• Counsels, guides and instructs Health Plan employees on adherence to accreditation standards, NCQA-focused activities and other quality improvement initiatives.


• Supports the Plan committee functions and activities as assigned. Ensures that meetings are organized, well documented and that they meet the Plan goals and objectives and the individual Committee's roles and responsibilities.


• Leads quality projects as directed, including appropriate audits and state projects and requirements.


• Assumes project management as directed.

Qualifications

Required

• Associate degree in a health care field or equivalent work.


• Four (4) years' experience with a government regulated health organization or a managed care setting with at least two (2) years’ experience performing complex quality management activities including HEDIS, NCQA etc.

Preferred

• Bachelor’s in healthcare or related field.


• Experience writing quantitative and qualitative analysis.


• Knowledge of the National Committee on Quality Assurance (NCQA) Standards for the accreditation of managed care organizations and HEDIS specifications; the managed care environment and the basic tenets of continuous quality improvement.

Additional Information

• Schedule: Full-time


• Requisition ID: 26002953


• Daily Work Times: 8:30 am - 5:00 pm


• Hours Per Pay Period: 80


• On Call: No


• Weekends: No