Senior Utilization Management Compliance and Accreditation Specialist

Role Overview

• Leads the Government Programs utilization management (UM) compliance functions
• Ensures adherence to URAC/NCQA standards
• Drafts and maintains procedures, materials and reports for compliance
• Analyzes and monitors UM and CR compliance metrics
• Identifies potential compliance risks or barriers to maintaining URAC/NCQA accreditation
• Supports regulatory and accreditation-related audits
• Partners with department leadership to support compliance and quality goals
• Participates in developing internal educational programs on compliance requirements
• Maintains detailed project plans for URAC/NCQA standards monitoring
• Oversees the URAC/NCQA survey process for utilization management

Requirements

• Bachelor's degree in business administration, public administration, or a related field
• Seven years of experience in NCQA and/or URAC quality management or compliance auditing standards
• General knowledge of federal and state laws, rules, and regulations
• Strong verbal and written communication skills
• Effective relationship building and interpersonal skills
• Strong data analytical and problem-solving skills
• Ability to use independent judgement to make decisions
• Ability to multitask and work on multiple projects at any given time
• Experience with Microsoft Office applications

Benefits

• Medical, dental and vision coverage
• Short
• and long-term disability
• Life insurance
• 401(k) savings plans
• Flexible spending accounts
• Tuition reimbursement or educational assistance
• Annual incentive compensation based on annual business goals
• Eight hours of paid volunteer time each year
• Access to an on-staff health coach and personal trainer
• Many other perks