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At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.
Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.
Reporting to the Director, Enterprise Accreditation Programs, the Enterprise Accreditation Programs Manager has corporate responsibility for accreditation (health plan and multicultural health care) for all Medicaid, Medicare and Long Term Services and Support plans. In addition to supporting the NCQA activities for the enterprise related to utilization management, behavioral health, population health, network management or delegation requirements this position will ensure policy standardization and implementation for the health services organization.
Responsibilities include the following:
Participate in the development and management of the strategy to support health plan and multicultural health care accreditation across the enterprise.
Serves as the enterprise-wide professional expert and liaison for accreditation related to one or more of the following subject matter areas: utilization management, behavioral health, population health, network management or delegation requirements within the standards.
Oversight of new and existing standards to ensure compliance to NCQA standards across all impacted subject matter or functional areas; support the design, implementation, and ongoing monitoring of policies, systems, and processes required to remain compliant.
Monitors performance against requirements and ensures compliance through continual review, audit and monitoring.
Collaborates with business owners to establish, implement, develop, and execute best practices to support accreditation (health plan and multicultural).
Implements opportunities for process improvement that impact accreditation across organizational lines of business.
Maintains knowledge of company policies and procedures to ensure compliance and support of standards in all levels of government (Local, State & Federal).
Previous experience in managing utilization management, behavioral health services or population health required
Experience with NCQA standards, submissions and on-site reviews
Medicaid and Medicare experience preferred
30-40 % travel required
Strong written and oral communication skills required
Proficient in Microsoft Word, Excel and PPT
Experience with compliance programs and/or policy development preferred
Bachelors degree required
RN, MSW or Licensed Behavioral Health professional
Amerihealth Caritas Health Plan