Utilization Management Accreditation Consultant

w3r Consulting; Town of Texas (WI); Hybrid; USD 100,000 - 140,000; Full time

Job summary

w3r Consulting is seeking an experienced professional to lead the NCQA UM accreditation initiative in the United States. This role is primarily remote with occasional travel to Chicago or Houston. The ideal candidate has over 10 years in managed care operations and strong knowledge of NCQA standards.

You will be responsible for building scalable operating models and establishing audit readiness. The engagement aims for operational launch and readiness for audit within 6 months.

Qualifications

• 10+ years in UM / managed care operations / accreditation / quality / compliance.
• Strong knowledge of NCQA UM standards and survey methodology.
• Experience designing/implementing UM programs in health plans or delegated environments.

Responsibilities

• Lead the NCQA UM accreditation initiative end-to-end.
• Interpret and operationalize NCQA UM standards across the UM program.
• Perform current-state assessment + gap analysis to identify risks.

Skills

UM / managed care operations

NCQA UM standards

Survey methodology

Change management

Job description

Location: Primarily Remote (occasional travel to Chicago or Houston)

Duration: ~12 months | Hours: 40/week

What you’ll do

• Lead the NCQA UM accreditation initiative end-to-end (readiness plan, milestones, documentation, survey prep
• Interpret and operationalize NCQA UM standards across the UM program
• Perform current-state assessment + gap analysis to identify risks to accreditation/scalability
• Build a scalable UM operating model, including governance, escalation pathways, and oversight
• Develop/strengthen UM documentation (policies, workflows, process maps, decision protocols, appeals, QA monitoring
• Establish performance reporting and audit readiness processes
• Deliver training and support change management across teams

Required experience

• 10+ years in UM / managed care operations / accreditation / quality / compliance
• Strong knowledge of NCQA UM standards and survey methodology
• Experience designing/implementing UM programs in health plans or delegated environments (IPA/MSO/ACO/MCOM)

Nice to have

• Experience achieving NCQA UM Only Accreditation
• Background with delegated UM arrangements and Medicare Advantage operations.
• Consulting experience supporting accreditation readiness

Engagement highlights

• Target operational launch
• Goal: be ready for audit within 6 months of operations
• Build a foundation that scales for additional payer partnerships