Job details
Job type full-time
Full job description
Primary city/state:
Phoenix, arizona
Department name:
Operations
Work shift:
Day
Job category:
General operations and culinary services
The future is full of possibilitiesAt banner health, we’re excited about what the future holds for health careThat’s why we’re changing the industry to make the experience the best it can beIf you’re ready to change lives, we want to hear from you.
The accreditation specialist will work with many different areas within the insurance divisionOur goal of achieving accreditation for the health plan and other lines of business are met by making sure our policies and processed are aligned with regulatory standardsA typical day can include researching policies to match standards, revising policies if necessary, working with vendor oversight in auditing delegates, citing policies and attending workgroups to review reports, processes, etcTo determine if we need to establish new or revise current processes.
Help move health care into the futureAt banner health we are changing health care to make the experience the best it can beIf that sounds like something you want to be part of, apply today.
Banner health network (bhn) is an accountable care organization that joins arizona`s largest health care provider, banner health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for maricopa county and parts of pinal countyThrough bhn, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.
Position summary
This position plans, coordinates, implements prepares and evaluates phso functional areas for ongoing accreditation requirementsThis position acts as a subject matter expert to leadership, staff and system teams/work groups as related to regulatory requirements to ensure standards are metThis position is responsible for assisting with ensuring ongoing compliance and operational performance of new and existing accreditation programs and projects (urac or ncqa)Works both independently and collaboratively with all functional areas with the purpose to support the development, implementation, maintenance, monitoring, and continuous improvement of accreditation processesMust possess advanced organizational and matrixed management skills to manage highly complex ongoing and periodic processes.
Core functions
1Responsible for the implementation of accreditation requirements using standardized accreditation processes in one or more functional areasEnsures all accreditation and policy guidance are disseminated in a timely manner and that such guidance is strictly adhered to, implemented and monitored and that evidence of implementation is verified and documentedPrepares departments for surveys by evaluating operational procedures for alignment with accreditation requirementsReviews, evaluates and assists in the development and implementation of facility/entity policies, procedures and guidelines as they relate to accreditation complianceMakes recommendations on all facility matters related to compliance with urac and/or ncqa.
2Conducts observations, document reviews and interviews to ascertain facility or department compliance with standards, rules and regulationsDocuments findings and provides facility or department with reports and recommendations for changeCollaborates with all functional areas within phso and greater banner health to ensure accreditation requirements are metManages the production of a quarterly accreditation dashboardEnsures functional areas are compiling and reporting the data that comprise the quarterly accreditation dashboard.
3Provides tools for ongoing measurement and reporting of compliance with accreditation standardsSupports development and monitors completion of facility plans of correctionOversees and assists functional teams and department managers in the development of corrective actions.
4Reports on compliance trends and recommends improvement strategiesPresents data and reports deficiencies identified during internal observations, and the status of implementation of action plans at operational meetingsReports facility or department readiness status on an ongoing basis.
5Serves as primary liaison with accreditation agencyServes as a subject matter expert on internal and external accreditation standardsProvides education to address accreditation changes and gaps in accreditation complianceProvides guidance to leaders and staff to ensure they understand accreditation requirementsServes on assigned committees, as chair or co-chair as appointedSchedules and maintains accreditation meetings, updating the committees on current and future plans and procedures, capabilities and actions.
6Maintains accreditation expertise through independent study as well as attending education workshops, tracking and reviewing regulatory changes, reviewing professional publications, establishing personal networks, and participating in professional societiesParticipates and leads process improvement projects relating to accreditation activities or improvement of customer satisfaction.
710% of overall responsibilities include assisting bhn/phso sr medical director (chair) with quarterly banner plan administration quality management committee and bpa quality review committee responsibilities ensuring all urac and/or ncqa quality reports and standards are metProvides annual updates to the qm program description and coordinates annual reports to the bpa board of directorsSupports business areas with quality activities as needed.
8This position interacts with a multitude of directors, managers and staff throughout the systemThe diversity of areas includes department or other banner executives, operational management and staff, staff and contracted physicians and clinicians, executives and managers with external partners or companies, including regulators and surveyors.
Minimum qualifications
Requires knowledge as typically obtained through a bachelor’s degree in business or other healthcare related field.
Requires a strong knowledge of regulations and standards within area of focus as typically attained with 5 years relevant experience in a health plan setting, plus 3 years regulatory experienceRequires the ability to manage programs, projects and databasesRequires demonstrated excellence in interpersonal and written communication skills, plus the ability to teach new concepts to adult learnersMust possess demonstrated flexibility in responding to the needs of multiple constituencies with a service-oriented philosophyMust possess strong planning skills and problem-solving skillsMust possess strong oral and written communication skills to effectively interact with senior management team, physicians and federal and state governing and regulatory entitiesDemonstrated ability to lead and facilitate interdisciplinary teams.
Preferred qualifications
Prior experience with in a surveyor or regulator role, experience in process improvement, regulatory/accreditation programs, health plan operations, and/or quality management preferredGraphic development and presentations is also preferred.
Additional related education and/or experience preferred.
