RN - Accreditation and Compliance (ks700-ah)
Nursing | Chicago, IL | Full Time and Temp to Perm
RN - Accreditation and Compliance
We are currently seeking to find a Registered Nurse for a temp to hire opportunity. Our client has a well-known reputation for being a great place to work and has been recognized with awards many times by various organizations for their work environment. The company fosters a team-oriented environment where both managers and team members work together and support each other. Th company is very large and offers unlimited growth opportunities. They also employ nurses to perform a plethora of different job duties so when you’re seeking a different challenge, you can easily move to a different area so you’ll always be challenged and never get bored. It really is an amazing opportunity.
In a nutshell, our client is seeking an RN who will be responsible for compliance with accreditation and regulatory requirements. You will develop, coordinate, integrate and monitor accreditation activities. You will also collect data and develop compliance documents/evidence for accreditation surveys; evaluate current practices; identify compliance gaps and recommend solutions to close gaps; and coordinate accreditation surveys.
- Lead accreditation review planning, coordination and execution of desktop and onsite reviews.
- Define and oversee creation of effective and timely reporting to support the quality and accreditation objectives of the Enterprise Quality & Accreditation department. Run and utilize accreditation reports, as required to manage and track accreditation compliance efforts.
- Oversee/lead completion of state Departments of Insurance submission of reports and audits.
- Lead and coordinate activities related to the successful completion of projects and written documentation of standards to meet external accreditation requirements (NCQA, URAC, etc.).
- Assist with development of training manuals and materials, reports, and materials to support NCQA/URAC compliance and regulatory operations.
- Collaborate, educate and routinely meet with staff/leadership throughout the organization to educate, discuss compliance activities, provide guidance, and monitor ongoing NCQA/URAC standards compliance.
- Coordinate NCQA/URAC accreditation activities and participate in onsite and/or virtual audits, as assigned, and assist in timely completion of NCQA/URAC application, NCQA/URAC requests, desktop reviews and onsite reviews, as assigned.
- Maintain all required licensure requirements (including Utilization Review Agent (URA)) in each state of operation.
- Serve as a consultant among internal areas of the company and external accreditation agencies to direct activities, which ensure standards and requirements, are met. Assess compliance with standards, prepare recommendations and action plans and ensure actions are taken to correct any deficiencies.
- Bachelor’s degree and 2 years of experience in managed care environment
- 6 years of work experience in managed care environment. Managed care environment experience includes one or more of the following areas: audit, health plan operations, compliance or legal.
- 2 years Accreditation experience (i.e. NCQA, URAC, Joint Commission, CMS) to include managing survey/review experience.
- Knowledge of health care regulatory and legislative process; experience reading and interpreting legislation.
- Experience using Total Quality Management (TQM)/Continuous Quality Improvement (CQI) concepts.
- Ability and willingness to travel, including overnight stays (2-3 times per year)
We support a diverse workforce and is an Equal Opportunity Employer who does not discriminate against employees and applicants for employment on the basis of race, gender, color, religion, national origin, age, sexual orientation, gender identity, genetic information, disability, veteran status, or other classification protected by law.