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Job Summary
We offer remote work opportunities (AK, AR, AZ, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE,NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, WI & WY only)
Responsible for the development, implementation, education and maintenance of the URAC accreditation process for the TriWest Medical Management programs. This accreditation program demonstrates the organization’s commitment to upholding and improving outcomes for our beneficiary’s throughout the healthcare continuum. This individual will have a broad knowledge of the regulatory and accreditation landscape and function as a subject matter expert to ensure alignment and continued adherence to URAC standards across all programs.
- Veterans, Reservists, Guardsmen, and military family members are encouraged to apply**
Education & Experience
Required:
- Bachelor’s degree in Business, Health Care Administration or related field or equivalent education and experience (I.E. Associate Degree with 5+ years of accreditation support experience)
- Minimum of 3 years of Accreditation support experience (URAC, NCQA, CMS) in a Managed Care Organization (MCO) or healthcare system
- Demonstrated experience managing and facilitating onsite and virtual audits and surveys
- Demonstrated experience in reading and interpreting regulatory, accreditation and contractual standards.
Preferred
- Project Management experience and/or certification strongly preferred
- Experience in data management, analytics and report building
- Experience in program and outcome assessments
Key Responsibilities
- Act as a URAC subject matter expert to Medical Management and organizational leadership team.
- Plan, develop, design and implement tools, process and policy compliant with accreditation and regulatory standards.
- Monitoring and maintenance of data and metrics as compliance evidence.
- Educating staff across the organization regarding URAC Accreditation standards and requirements.
- Evaluating current practices; identifying compliance gaps and recommending solutions to close gaps.
- Actively lead URAC accreditations onsite visits and desktop reviews.
- Monitor regulatory agencies and standards for changes and updates.
- Interpret standards and collaborate with operational leadership to translate into operational workflow and tools.
- Assist with the development of training materials and reference materials to support URAC compliance.
- Identify accreditation/regulatory compliance improvement opportunities and collaborate with leadership on creating action plans to address.
- Design, develop and maintain accreditation and survey readiness plan and tools to ensure requirements and standards are always met.
- Defines and tracks necessary reports and metrics reflecting stability as relates to accreditation and regulatory compliance survey readiness.
Competencies
Commitment to Task: Ability to conform to established policies and procedures; exhibit high motivation.
Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.
Computer Literacy: Ability to function in a multi-system Microsoft suite of applications, TriWest Intranet, the Internet, and department software applications.
Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.
Empathy / Customer Service: Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position.
Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.
High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.
Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.
Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.
Technical Skills: Knowledge of TRICARE programs and benefits, Managed Care concepts, and healthcare principles and delivery systems, URAC utilization, case and disease management standards; utilization, case and disease management interventions, collaboration skills, legal and regulatory requirements, HIPAA privacy regulations, and proficient with Microsoft suite of applications.
Working Conditions
Working Conditions
- Regular and reliable attendance
- Availability to work non-regular hours as needed
- Ability to travel as needed
- Extensive computer work with prolonged periods of sitting
Company Overview
Taking Care of Our Nation’s Heroes.
It’s Who We Are. It’s What We Do.
Do you have a passion for serving those who served?
Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!
Our job is to make sure that America’s heroes get connected to health care in the community.
At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.
DoD Statement
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Benefits
We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:
- Medical, Dental and Vision Coverage
- Generous paid time off
- 401(k) Retirement Savings Plan (with matching)
- Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
- Tuition reimbursement
- Paid volunteer time
*Annual base salary for Colorado, Hawaii and Washington State residents: $67,000-$73,000 depending on experience*
Equal Employment Opportunity
TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.
