Senior Accreditation Specialist at Centene

**Who this is for** This role is for an experienced quality professional with a deep understanding of accreditation standards, specifically focused on helping h

Work type: remote

Location: Remote-FL | Remote-NC

Salary: $70,100 – $126,200/yr

Type: Full-time

Summary

**Who this is for** This role is for an experienced quality professional with a deep understanding of accreditation standards, specifically focused on helping healthcare plans maintain compliance and excellence. **Key highlights** You will lead accreditation readiness and quality improvement projects, working closely with senior leadership to resolve complex gaps and facilitate training on file elements. **You might be a good fit if you...** - Have 4+ years of experience in HEDIS, NCQA, or general healthcare accreditation. - Are skilled in conducting file reviews, auditing processes, and developing policy documentation. - Can successfully lead cross-functional QI projects and coordinate with delegated vendors. - Hold a CPHQ certification or are a licensed healthcare professional.

Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose: Serves as a SME regarding accreditation standards and continuous quality improvement principles. Coordinates and performs accreditation oversight and survey readiness. Serves as a lead communicator with health plan and department senior leadership.

• Develop and coordinate delegation oversight mechanisms for complex plans (multiple products, large populations, known gaps, critical time frame for achieving accreditation, etc.)


• Conduct file review, identify gaps, communicate results and perform re-audits as required.. Reviews and updates tools, process documentation and policies related to accreditation.


• Develop and maintain accreditation readiness schedule.


• Create policy and procedures to support accreditation activities.


• Provide training on complex issues affecting identified NCQA file elements, inclusive of creating appropriate training materials as needed and supporting improvement activity carried out either at the health plans or on a corporate basis


• Develop QI, NCQA and HEDIS projects with delegated vendors to support accreditation maintenance and HEDIS reporting.


• Coordinate assigned NCQA and HEDIS work plan activities.

License/Certification: CPHQ certification preferred; Licensed healthcare professional preferred

Pay Range: $70,100.00 - $126,200.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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