Remote Utilization & Accreditation Specialist II

MedImpact; San Diego (CA); On-site; USD 69,000 - 119,000; Full time

Benefits offered by this job

Medical / Dental / Vision / Wellness

Paid Time Off / Holidays

401K with company match

Life and Disability Insurance

Tuition Reimbursement

Employee Referral Bonus

Job summary

MedImpact is seeking a qualified professional to drive annual accreditation, clinical quality, and UR licensure readiness across Commercial, Medicare, Medicaid, and Marketplace programs. You will manage NCQA/URAC readiness, oversee delegations, and coordinate with clients and internal teams to ensure timely, accurate compliance deliverables.

The role requires NCQA/URAC expertise, a healthcare license, and 5+ years in PBM or managed care.

Qualifications

• NCQA and URAC accreditation standards expertise required.
• 5+ years of experience in PBM, managed care, or provider setting.
• Healthcare licensure or eligibility is required.

Responsibilities

• Lead accreditation readiness activities and evidence development.
• Coordinate with internal partners and delegated entities for compliance.
• Prepare reports and responses for accrediting bodies and regulators.
• Maintain documents and policies to meet standards.
• Provide training and guidance on accreditation requirements.

Skills

NCQA standards

URAC standards

Quality management

PBM experience

Audit readiness

Education

BS/BA in healthcare-related field

Tools

Microsoft Office Suite

Teams

PDF/document tools

Document management systems

Job description

MedImpact is seeking a qualified professional to drive annual accreditation, clinical quality, and UR licensure readiness across Commercial, Medicare, Medicaid, and Marketplace programs. You will manage NCQA/URAC readiness, oversee delegations, and coordinate with clients and internal teams to ensure timely, accurate compliance deliverables.

The role requires NCQA/URAC expertise, a healthcare license, and 5+ years in PBM or managed care.