Accreditation and Delegation Nurse

Western Health Advantage•Sacramento, CA

2d•$119,000 - $135,000•Hybrid

About The Position

Western Health Advantage is seeking an experienced Accreditation and Delegation Nurse to support management of its Quality Improvement Program and NCQA accreditation activities. The role promotes continuous performance improvement, supports regulatory and accreditation readiness, and serves as a resource on NCQA standards for internal departments and delegated Medical Groups. The position provides project leadership for NCQA Health Plan and Health Outcomes accreditations; supports year-round readiness for NCQA accreditation and DMHC regulatory surveys; and coordinates audits, survey preparation, documentation, and follow-up. It also coordinates Quality Improvement projects, oversees delegated functions, monitors results and reporting, and contributes to program documents, policies, committee materials, and process-improvement activities. The role collaborates with internal teams, Medical Groups/IPAs, and Specialty Plans, and serves on the Quality Improvement Committee.

Requirements

Bachelor’s degree in nursing or a healthcare-related field.
Valid California Registered Nurse license before employment and maintained throughout employment.
At least four years of experience in healthcare quality, including Quality Improvement projects, medical record reviews, focused studies, and management of complaints, grievances, or Potential Quality Issues.
One to two years of experience participating in NCQA accreditation readiness.
Experience using specialized software and electronic health record systems.
Strong mathematical and analytical abilities, including accuracy when tabulating data and calculating rates.
Ability to identify data variations, analyze trends, evaluate processes, and present findings in clear reporting formats.
Strong project management, organizational, communication, and collaboration skills.

Nice To Haves

At least one year of survey experience.
Certified Professional in Healthcare Quality certification.

Responsibilities

Provide leadership for projects supporting WHA’s NCQA Health Plan and Health Outcomes accreditations.
Help maintain year-round readiness for NCQA accreditation and DMHC regulatory surveys.
Prepare reports and documentation, support onsite reviews, and coordinate post-survey follow-up activities.
Conduct internal audits of required performance measures and supporting documentation.
Communicate NCQA standards and guide key personnel on meeting accreditation requirements.
Coordinate Quality Improvement projects by establishing indicators and methodologies, collecting and analyzing data, implementing interventions, and evaluating outcomes.
Prepare member and provider materials and support systems and process-improvement activities.
Track and trend project results, compile summary reports, and maintain complete project documentation.
Collaborate with Medical Management, internal departments, delegated Medical Groups/IPAs, and Specialty Plans to support Quality Improvement Program goals.
Oversee delegated functions by monitoring activities, reporting requirements, and opportunities for improvement.
Ensure delegation agreements are updated as NCQA standards change and provide summary reports to the Quality Improvement Committee.
Support readiness for recommendations issued by the DMHC Health Equity and Quality Committee.
Assist with developing and revising Quality Improvement Program documents, policies and procedures, quarterly and annual reports, and committee presentations.
Serve as a member of the Quality Improvement Committee and chair other committees as assigned.
Manage workflows to ensure project requirements and reporting deadlines are met.
Perform additional duties and special projects as assigned.