NCQA Accreditation Quality Specialist (RN or NP)
Who You Are
You are a devoted, compassionate, and enjoy being on the front lines in healthcare, changing the lives of patients by supporting them and the team by focusing on customers. You’re excited about being part of a team that is building a healthcare delivery model that ensures the highest possible quality of life and best outcomes for those in our care. You believe people with Medicare deserve the best person-centered, holistic, comprehensive care and want to influence the healthcare system to drive towards that. You’re creative and innovative when it comes to sharing and communicating important information. You’re passionate about thinking through operational design, execution, and challenges to deliver on the care promises made to patients and nephrologists. You thrive in innovative and evolving environments with high rates of change. Does this sound like you? If so, we should talk.
Who We Are
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. We believe patients living with kidney disease deserve the best care and we are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants. We help nephrologists focus on the right patients at the right time across the full care spectrum. We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical insight and tools, and services to patients. We listen to the needs of our patients, our employees, and our client partners, continually working to push beyond the status quo in which the care system manages patients today.
The Clinical Quality Accreditation Specialist is responsible for collaborating with senior and executive leaders in obtaining and managing NCQA accreditation by leveraging expertise in quality measurement and reporting, particularly in the areas of HEDIS, Star Rating (including CAHPS, HOS), Pay for Performance and Medicare/Medicaid. You will get exposure to development and growth opportunities, an opportunity to build a national networking base, and the ability to work among some of the most sought-after thoughtful leaders in the health care space.
Primary functions for the Senior Manager of Clinical Program Development include:
- NCQA Accreditation: Lead the effort to obtain and maintain NCQA accreditation for Evergreen Nephrology. Stay abreast of NCQA guidelines and requirements.
- Quality Measurement and Reporting: Utilize in-depth knowledge of HEDIS, Star Ratings, Pay for Performance and Medicare/Medicaid to develop and implement strategies for continuous improvement in clinical quality measures.
- Clinical Policies and Procedures: Develop, review, and update clinical policies and procedures to ensure compliance with quality accreditation standards. Maintain a comprehensive repository of policies.
- Documentation and Compliance: Ensure accurate and complete documentation of quality-related activities. Monitor compliance with regulatory requirements and accreditation standards.
- Collaboration: Work closely with cross-functional teams, including clinical, CDQI, operations, market leaders, and IT, to integrate quality initiatives into daily operations.
- Data Analysis: Conduct data analysis to identify trends, gaps, and opportunities for improvement. Provide insights and recommendation based on data-driven findings.
- Training and Education: Develop and deliver training programs to staff on quality measurements, reporting requirements, and clinical policies and procedures.
- Performance Monitoring: Implement processed for monitoring and reporting on performance metrics related to quality accreditation. Take corrective actions as needed.
- Audit Preparation: Prepare the organization for internal and external audits related to quality accreditation. Ensure readiness and compliance with audit requirements.
How You Qualify
- You reviewed the Who You Are section of this job posting and immediately felt the need to read on. That makes you a match for our innovative culture.
- You are a Registered Nurse or Nurse Practitioner, with an active license in good standing, with prior experience working in a value-based care management program.
- Minimum of 5 years of experience in a similar role, with a focus on quality accreditation in healthcare.
- Bachelor’s degree required, Master’s preferred.
- Certifications: Certified Professional in Healthcare Quality - CPHQ (preferred), Lean Certified
- Strong experience with NCQA standards, HEDIS measures, Star Rating system, Pay for Performance, and Medicare/Medicaid requirements.
- Experience in creating and maintain clinical policies and procedures.
- Excellent analytical and problem-solving skills with proficiency in data analysis tools.
- Effective communication and interpersonal skills.
- Experience in developing and delivering training programs.
- Detail-oriented with a commitment to accuracy and compliance.
- Knowledgeable and passionate about person-centered clinical program design.
- Influential leadership experience in value-based care management.
- Excellent communication skills with demonstrated ability to achieve stakeholder buy in to drive change management.
- Technologically advanced with strong data driven decision making.
- The ability to manage multiple priorities and deliver timely project requirements while ensuring departmental needs are met.
- You accept that things change quickly in a startup environment and can pivot quickly to meet program needs.
Pay range for this role is $80,000 to $85,000, with exact pay determined based on experience, education, demand for role, and other role-specific criteria.
How You are Supported
- You will benefit from Evergreen Nephrology’s exceptional total rewards package, including competitive base pay with bonuses, paid time off starting at 4 weeks for full time employees, 12 paid holidays per year, reimbursement for continuing medical education, 401k with match, health, dental, and vision insurance
- Family friendly policies that support paid parental leave and flexible work arrangements.
- As a team member you’ll be supported by our robust commitment to training and development that starts with onboarding and continues throughout your career with Evergreen Nephrology
- You will collaborate with like-minded healthcare professionals who, like you, understand the importance and value of Evergreen Nephrology’s high-quality, value-based, care model
Evergreen Nephrology is an equal opportunity employer that is committed to inclusion and diversity. We take affirmative action to ensure equal opportunity for all applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics. Learn more about your EEO rights as an applicant (Opens in a new window) .
Evergreen Nephrology will not discriminate or retaliate against applicants who inquire about, disclose, or discuss their compensation or that of other applicants. United States Department of Labor. Learn more (Opens in a new window) .
Evergreen Nephrology is committed to working with and providing reasonable accommodations to job applicants with physical or mental disabilities. Applicants with a disability who require a reasonable accommodation for any part of the application or hiring process should email email@example.com for assistance. Reasonable accommodations will be determined on a case-by-case basis.