Summary of Position Lead and facilitate accreditation and regulatory activities as applicable to accreditation, including but not limited to NCQA accreditations, and as applicable, CMS, DOH, DFS, and other regulatory and accrediting bodies specific for the Plan thereby meeting employer group, regulators and Plan requirements. Implementation and oversight of strategies developed to improve operational performance towards meeting requirements. Ensure compliance with applicable accreditation organization standards through ongoing evaluation, monitoring and reporting, and collaboratively engaging with colleagues to address the requirements to ensure compliance. Principal Accountabilities
- Independently evaluate and address with Plan colleagues, compliance with organizational accreditation and regulatory requirements; conduct ongoing monitoring, data/documentation collection and reporting to ensure continued adherence to organizational accreditation and regulatory requirements; monitor delegate/vendor documentation for compliance with applicable requirements.
- Identify deficiencies and recommend solutions to support the implementation of updated and new accreditation and regulatory standards.
- Ensure full compliance with requirements: review, trend, analyze data and information; develop, prepare and present reports to the appropriate quality committees to meet accreditation requirements.
- Assess policies and procedures for compliance and revise or propose revisions to bring into full compliance with accreditation and regulatory standards as applicable; ensure timely review, updates and revisions of policies and procedures to comply with accreditation standards, and business requirements.
- Train stakeholders/EmblemHealth colleagues in accreditation requirements; ensure accreditation standards are built into EmblemHealth departmental processes and policies.
- Monitor, track, and document deliverables related to organizational accreditation processes and those that intersect with regulatory requirements; identify and assemble documentation required for accreditation survey submissions and regulatory audits.
- Coordinate accreditation, and as applicable regulatory, organization preparedness activities; educate and support operational area representatives regarding accreditation requirements; interface with key staff and consultant(s) involved in survey/audit preparations and on-site survey/audit preparations, and audit survey and processes.
- Address NCQA health plan delegation standards, health equity accreditation standards, and other accreditation standards as needed.
- Participate in strategic planning and development of accreditation and regulatory activities as applicable, as well as initiatives to improve quality and service. Establish and lead work teams, work groups and committees to address specific accreditation and regulatory standards requiring focused attention as needed.
- Develop meeting agendas, develop work plans and presentations.as needed. Scribe and write minutes as needed.
- Provide follow-up for quality initiatives and activities related to the implementation of new standards and ongoing compliance of existing standards.
- Provide support for regulatory compliance activities (City, State, Federal and corporate specific) as directed.
- Develop and maintain inter-departmental and delegate relationships to ensure efficiency and fluidity of accreditation initiatives. Initiate and track JETPACs and communication requests as necessary to ensure implementation of applicable website enhancements and member/provider communications to support accreditation requirements.
- Perform mock file audits to evaluate and provide feedback on accreditation file review elements as needed; monitor corrective action plans, when applicable.
- Perform other duties as assigned or required.
Qualifications
- Bachelor's degree in health care, business, or related field; master's preferred
- 4 - 6+ years' managed care experience including 3 years accreditation or regulatory experience (NCQA, URAC, CMS, DOI, DOH, etc.) (Required)
- Management/project management experience (Required)
- Additional experience/specialized training may be considered in lieu of educational requirements (Required)
- Detailed knowledge of accreditation processes, policies, standards, and requirements (Required)
- Strong communication skills (verbal, written, presentation, interpersonal, facilitation) with all audiences (Required)
- Proficiency in MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) Required)
- Proven track record of successfully managing simultaneous multiple projects within defined parameters (Required)
- Ability to exercise discretion/use independent judgment when obtaining, compiling and distributing information and data (Required)
- Strong problem solving, analytical, and negotiating skills paired with strong attention to detail (Required)
- Leadership and management experience within an operation that addresses complex relationships and multiple stakeholders with conflicting goal and priorities (Required)
- Flexible with changes, processes, and procedures to meet the Plan and program needs (Required)
- Ability to establish and maintain positive working team relationships with business partners, delegation team and department members, and external stakeholders by effectively communicating the Plan and department's expectation to adhere to accreditation requirements (Required)
- Demonstrated ability to manage conflict, build, support, mentor, and monitor teams and the ability to recognize and address positive behaviors that contribute to successful achievement of plan goals. Ability to establish, interact and work effectively in a team environment (Required)
Additional Information
- Requisition ID: 1000003427
- Hiring Range: $68,040-$118,800
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EmblemHealth
Nov 09, 2026