Accreditation Project Manager

ChristianaCare • Wilmington, DE

21h • Onsite

About The Position

ChristianaCare is searching for an Accreditation Project Manager for Inpatient Authorization Delegation to oversee the planning, execution, monitoring, and optimization of projects related to inpatient utilization management (UM) and delegated authorization functions. This role ensures all the work done by the Utilization Management department meets all regulatory, contractual, and operational requirements for inpatient authorization processes. The position collaborates closely with clinical leadership, compliance, IT, and external partners to maintain high-quality, timely, and compliant inpatient authorization and review operations.

Requirements

• Previous experience working in healthcare accreditations
• Experience managing, auditing, and maintaining compliance with healthcare industry-specific standards
• Bachelor’s degree in healthcare administration, business, nursing, public health, or related field.
• A minimum of three years of experience in healthcare project management, utilization management, delegation oversight, or inpatient authorization operations.
• Experience working with delegated UM models (IPA/MSO/ACO) is strongly preferred.
• Familiarity with regulatory requirements for UM (CMS, NCQA, DHCS, DMHC).
• Experience with inpatient authorization criteria (InterQual, MCG) is a plus.

Nice To Haves

• Data Analysis skills are a strong preference, but not a requirement
• Master’s degree preferred (MPH, MHA, MBA, MSN).

Responsibilities

• Organize and support UM projects as assigned. Includes organizing project scope, expenses, timelines, task lists, training, testing and go live plans. Communication with stakeholders, and maintenance of project files. At project closure, coordinates a smooth transition to support operations, including effectively transferring relevant knowledge and operational materials to designated staff, as requested by department leadership.
• Act as a liaison between system users and technical teams, translating user needs into technical specifications.
• Lead end‑to‑end project management for initiatives related to inpatient authorization workflows, system enhancements, and process improvements.
• Develop project plans, timelines, risk logs, and communication strategies to ensure successful execution.
• Coordinate cross‑functional teams including UM nurses, medical directors, IT analysts, compliance, and provider relations.
• Facilitate project meetings, document decisions, and ensure accountability for deliverables.
• Monitor project performance metrics and escalate risks or barriers to leadership.
• Oversee UM requirements related to regulatory and compliance requirements, including CMS, NCQA, and health plan policies.
• Support or lead delegation audits, including pre‑delegation, annual audits, and ongoing monitoring.
• Track corrective action plans (CAPs), validate remediation, and ensure timely closure of findings.
• Maintain documentation of delegation agreements, audit results, and compliance reporting.
• Ensure delegated entities follow evidence‑based criteria (e.g., InterQual, MCG) and meet turnaround time (TAT) standards.
• Monitor inpatient authorization workflows to ensure accuracy, timeliness, and regulatory compliance.
• Analyze inpatient utilization trends, denial patterns, readmission indicators, and authorization volumes.
• Partner with clinical leadership to resolve escalated inpatient authorization issues or complex cases.
• Identify operational gaps and recommend process improvements to reduce delays and improve member outcomes.
• Develop and maintain dashboards, scorecards, and performance reports for inpatient authorization and delegated UM activities.
• Track key performance indicators (KPIs) such as TAT, denial rates, overturn rates, and audit findings.
• Present data insights to leadership and stakeholders to support decision‑making.
• Collaborate with analytics and IT teams to ensure data accuracy and integrity.
• Serve as the primary liaison between the organization and delegated entities for inpatient authorization matters.
• Build strong working relationships with provider groups, hospitals, and vendor partners.
• Communicate policy updates, workflow changes, and audit expectations clearly and professionally.
• Provide training and guidance to internal teams and delegated partners as needed.

Benefits

• Full Medical, Dental, Vision, Life Insurance, etc.
• Two retirement planning offerings, including 403(b) with company contributions
• Generous paid time off with annual roll-over and opportunities to cash out
• 12-week paid parental leave
• Incredible Work/Life benefits including annual membership to care.com, access to backup care services for dependents through Care@Work, retirement planning services, financial coaching, fitness and wellness reimbursement, and great discounts through several vendors for hotels, rental cars, theme parks, shows, sporting events, movie tickets and much more!
• health insurance
• paid time off
• retirement
• an employee assistance program

What This Job Offers

• Job Type: Full-time
• Career Level: Principal
• Number of Employees: 1-10 employees