Consultant, Accreditation Compliance
About The Position
Navitus Health Solutions is seeking a Consultant, Accreditation Compliance to join their team. This role is a key member of the Accreditation Quality Team and is responsible for supporting and maintaining accreditation programs across Navitus. The position ensures compliance with accreditation standards delegated to or supported by Navitus Health Solutions through oversight of reporting, analysis, audits, validation activities, and continuous quality improvement initiatives. This role serves as a subject matter expert on accreditation standards and processes and provides consultation, guidance, and education to associates, leaders, clients, and other stakeholders. The Consultant partners across the organization to support accreditation readiness, quality management activities, delegation oversight, performance improvement initiatives, and successful accreditation outcomes.
Requirements
- Bachelor’s degree required in Healthcare Administration, Quality Management, Business Administration, Public Health, Pharmacy, or a related field, or equivalent work experience, required.
- 5+ years of experience in accreditation, compliance, quality management, or a related field required.
- Experience with accreditation programs such as URAC, NCQA, or similar accreditation organizations required.
- Experience interpreting and applying accreditation standards and leading accreditation readiness, survey preparation, audit, or compliance activities required.
- Participate in, adhere to, and support compliance program objectives.
- The ability to consistently interact cooperatively and respectfully with other employees.
Responsibilities
- Serve as a subject matter expert on accreditation standards, requirements, and interpretations; provide consultation, guidance, and training to associates, leaders, clients, consultants, and other stakeholders regarding accreditation expectations, compliance requirements, and best practices.
- Evaluate organizational practices, processes, and controls against applicable accreditation standards and identify opportunities to strengthen compliance, quality outcomes, and operational effectiveness.
- Serve as the primary liaison with accreditation organizations, consultants, and external stakeholders as appropriate, communicating accreditation updates, regulatory changes, and compliance requirements to support organizational readiness and ongoing compliance.
- Manage the Navitus Quality Management Program, including facilitating quarterly meetings, maintaining program documentation, and collaborating with departments to monitor performance metrics associated with applicable accreditation standards (e.g. URAC PBM, NCQA, etc.).
- Perform accreditation audits and assessments to evaluate compliance with applicable standards, identify performance gaps, and recommend corrective actions.
- Evaluate and enhance audit methodologies, quality processes, and performance measurement tools to improve operational efficiency, accreditation readiness, and organizational outcomes.
- Lead root cause analysis activities and partner with stakeholders to develop, implement, and monitor corrective action plans that address compliance risks and improve organizational performance.
- Collect and analyze quantitative and qualitative data, identify trends, risks, and opportunities, and provide recommendations that support continuous improvement and accreditation readiness.
- Develop, maintain, and continually improve documentation, strategies, processes, and objectives required to achieve and maintain accreditation and support client accreditation activities.
- Provide information, consultation, and training on accreditation standards, quality management practices, and industry best practices to associates, clients, and other stakeholders.
- Lead all aspects of accreditation surveys and reviews, including preparation, coordination, facilitation, communication, and follow-up activities necessary to maintain accreditation.
- Participate in client meetings and accreditation activities, representing Navitus’ accreditation position and providing consultative support related to accreditation standards and compliance requirements.
- Develop and maintain client specific delegation agreements in collaboration with current and future accredited health plan clients.
- Other duties as assigned.
Benefits
- Top of the industry benefits for Health, Dental, and Vision insurance
- 20 days paid time off
- 4 weeks paid parental leave
- 9 paid holidays
- 401K company match of up to 5%
- Adoption Assistance Program
- Flexible Spending Account
- Educational Assistance Plan and Professional Membership assistance
- Referral Bonus Program – up to $750!
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
