Remote Accreditation Compliance Consultant

Navitus Health Solutions / Lumicera Health Services; United States; À distance; USD 72 000 - 86 000; Plein temps

Avantages offerts par ce poste

Health, dental, and vision insurance

Paid time off: 20 days

Parental leave: 4 weeks

9 paid holidays

401K company match up to 5%

Adoption assistance

Flexible spending account

Educational + professional membership

Résumé du poste

Navitus Health Solutions is seeking a Consultant, Accreditation Compliance to join our team. The Consultant supports accreditation readiness, quality management, and compliance across Navitus, serving as a subject matter expert on standards and processes.

The role partners across the organization to drive readiness and outcomes. Responsibilities include audits, training, and liaison activities with accreditation bodies; the candidate will guide, educate, and advise associates, leaders, clients,

Qualifications

• Bachelor’s degree required in Healthcare Administration, Quality Management, Business Administration, Public Health, Pharmacy, or a related field, or equivalent work experience, required.
• 5+ years of experience in accreditation, compliance, quality management, or a related field required.
• Experience with accreditation programs such as URAC, NCQA, or similar accreditation organizations required.
• Experience interpreting and applying accreditation standards and leading accreditation readiness, survey preparation, audit, or compliance activities required.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

Responsabilités

• Serve as a subject matter expert on accreditation standards, requirements, and interpretations; provide consultation, guidance, and training to associates, leaders, clients, consultants, and other stakeholders regarding accreditation expectations, compliance requirements, and best practices.
• Evaluate organizational practices, processes, and controls against applicable accreditation standards and identify opportunities to strengthen compliance, quality outcomes, and operational effectiveness.
• Serve as the primary liaison with accreditation organizations, consultants, and external stakeholders as appropriate, communicating accreditation updates, regulatory changes, and compliance requirements to support organizational readiness and ongoing compliance.
• Manage the Navitus Quality Management Program, including facilitating quarterly meetings, maintaining program documentation, and collaborating with departments to monitor performance metrics associated with applicable accreditation standards (e.g. URAC PBM, NCQA, etc.).
• Perform accreditation audits and assessments to evaluate compliance with applicable standards, identify performance gaps, and recommend corrective actions.
• Evaluate and enhance audit methodologies, quality processes, and performance measurement tools to improve operational efficiency, accreditation readiness, and organizational outcomes.
• Lead root cause analysis activities and partner with stakeholders to develop, implement, and monitor corrective action plans that address compliance risks and improve organizational performance.
• Collect and analyze quantitative and qualitative data, identify trends, risks, and opportunities, and provide recommendations that support continuous improvement and accreditation readiness.
• Develop, maintain, and continually improve documentation, strategies, processes, and objectives required to achieve and maintain accreditation and support client accreditation activities.
• Provide information, consultation, and training on accreditation standards, quality management practices, and industry best practices to associates, clients, and other stakeholders.
• Lead all aspects of accreditation surveys and reviews, including preparation, coordination, facilitation, communication, and follow-up activities necessary to maintain accreditation.
• Participate in client meetings and accreditation activities, representing Navitus’ accreditation position and providing consultative support related to accreditation standards and compliance requirements.
• Develop and maintain client specific delegation agreements in collaboration with current and future accredited health plan clients.
• Other duties as assigned.

Connaissances

Accreditation knowledge

Quality management

Consultation and training

Stakeholder communication

Formation

Bachelor’s degree or equivalent in Healthcare Administration, Quality Management, Business Administration, Public Health, Pharmacy, or related field

5+ years of experience in accreditation, compliance, quality management, or related field

Description du poste

Navitus Health Solutions is seeking a Consultant, Accreditation Compliance to join our team. The Consultant supports accreditation readiness, quality management, and compliance across Navitus, serving as a subject matter expert on standards and processes.

The role partners across the organization to drive readiness and outcomes. Responsibilities include audits, training, and liaison activities with accreditation bodies; the candidate will guide, educate, and advise associates, leaders, clients,