NCQA Quality and Accreditation Specialist

The Quality & Accreditation Specialist is responsible for coordinating and maintaining accreditation activities for the Utilization Management (UM) and Credentialing departments. This includes supporting NCQA accreditation, implementing quality monitoring initiatives, conducting internal reviews, and preparing reports.

Requirements

• Coordinate all NCQA accreditation activities, including document preparation, maintenance of accreditation evidence, and survey readiness.
• Lead internal audit processes for UM and Credentialing, including planning, execution, data validation, documentation review, and reporting of findings.
• Support external audits as a shared responsibility with the Medical Management Operations team, including preparation, evidence collection, cross functional coordination, and follow up action plans.
• Develop internal audit tools, checklists, workflows, and monitoring structures to ensure ongoing compliance with NCQA, CMS, state, and health plan expectations.
• Monitor and analyze operational and data to identify trends, risks, and quality improvement opportunities.
• Implement and oversee quality monitoring initiatives to ensure continuous improvement and sustained accreditation readiness.
• Prepare reports and executive summaries of audit results, quality findings, and accreditation status updates for UM and Credentialing leadership.
• Educate and support UM and Credentialing staff on accreditation requirements, audit expectations, and quality standards.
• Partner with Medical Management operations teams and cross functional teams to resolve audit and accreditation related issues and maintain continuous readiness.
• Maintain up to date knowledge of NCQA standards, CMS/DOH requirements, and emerging accreditation or quality requirements.
• Perform other quality and accreditation related duties as assigned.

Benefits

• Competitive compensation and annual bonus program
• 401(k) retirement program with company match
• Company-paid life insurance
• Company-paid short term disability coverage (location restrictions may apply)
• Medical, Vision, and Dental benefits
• Paid Time Off (PTO)
• Paid Parental Leave
• Sick Time
• Paid company holidays and floating holidays
• Quarterly company-sponsored events
• Health and wellness programs
• Career development opportunities