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  • 1510 Meadow Wood Lane
    Reno, NV 89502

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Manager of Accreditation and Performance Improvement

Prominence Health Plan • Reno, NV

Posted 26 days ago

Job Snapshot

Full-Time
Healthcare - Health Services
Management

Job Competition

1

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Job Description

Founded in 1978, Universal Health Services, Inc. (UHS)* is one of the nation’s largest and most respected healthcare management companies, operating through its subsidiaries—acute care hospitals, behavioral health facilities and ambulatory centers nationwide. With more than 74,000 people employed by UHS subsidiaries, UHS’s business strategy is to continue to grow by building or purchasing healthcare facilities across the country, while continuing to strengthen UHS’s well-reputed franchise with its customary exceptional service and effective cost control. Our success is driven by a service philosophy based on integrity, competence, compassion, and a responsive management style. UHS has been recognized as a Fortune 500 company and is listed as one of Fortune’s Most Admired Companies. UHS’s Acute Care Division is comprised of 25 high performing hospitals and several ambulatory care facilities across the nation and prides itself on providing superior patient care. 

Prominence Health Plan, established in Reno in 1993 as St. Mary’s Health Plan, was acquired in 2014 by Universal Health Services (UHS), one of Fortune Most Admired Companies. 

In addition to the HMO, Prominence Health Plan also offers Point of Service health plans, a preferred health insurance company that offers Preferred Provider Organization (PPO) health plans, and CDS Group Health, a third-party administrator.

We are a fast-growing, rapidly-changing healthcare organization offering the excitement of a start-up with the support of a Fortune 500 company. We are looking for talented, enthusiastic people to help shape the future of our organization.

Job Summary:  The Manager of Accreditation and Performance Improvement is responsible for the leadership, development, management, implementation and execution of Prominence Health Plan’s Accreditation and Performance Improvement Program. The Manager works closely with clinical and business leaders in the development and implementation of accreditation initiatives aligned with the plan’s clinical, business, quality measurement and performance improvement strategies. Responsibilities include ensuring that the Accreditation Program meets or exceeds regulatory and accreditation requirements for: NCQA accreditation; facilitation of operational productivity metrics; performance improvement initiatives; development and implementation of the annual quality and chronic care improvement plans; management of the plan’s quality committees; quality of care complaints critical incident reporting; and, policies and procedures. This position reports to the Director of Compliance.

Job Requirements

Regulatory Requirements:

  • Experience with NCQA or other health plan accreditation standards, State and Federal laws, regulations, policies and practices for the administration of Medicare Advantage, Prescription Drug Plan, and managed care organizations.

Education:

  • Bachelor’s degree in business administration, healthcare administration, public health, organizational development or other related field; Master’s degree preferred. Relevant experience may be substituted for educational requirements for exceptional candidates.
  • Quality and/or performance improvement certification preferred.

Experience:

  • Minimum five years’ experience in health insurance or health care.
  • Minimum two years’ demonstrated successful experience in accreditation, performance improvement, compliance, administrative and/or operational duties in health care, preferably in a management role in a managed care organization.

Language Skills:

  • Ability to effectively communicate in English, both verbally and in writing.

Knowledge, Skills and Abilities:

  • Expertise applying continuous quality and performance improvement methodologies.
  • Expertise applying Three Lines of Defense in Effective Risk Management and Control.
  • Knowledge of Compliance Program principles to include analyzing risk assessments, performing audits, creating reports, educating and following up with the business area to ensure processes exist to demonstrate compliance with Federal and State requirements. 
  • Proficiency in gathering and interpreting empirical evidence, formulating recommendations, action plans and interventions to improve the overall organization strategy.
  • Simultaneous action at varying stages—initiation, follow through, and completion—on a number of different projects.
  • Demonstrated ability to research, analyze and interpret state/federal regulations related to health insurance and healthcare.

  • Demonstrated ability to communicate verbally and with technical writing in a way that effectively conveys project background, objectives, activities, evaluations, conclusions, and recommendations.
  • Demonstrated skills in critical thinking, problem solving, and the analysis, interpretation and evaluation of complex information.
  • Demonstrated ability to work independently with minimal supervision.
  • Demonstrated ability to maintain effective collaborative working relationships with staff.
  • Resourceful, detail-oriented, and able to assimilate and analyze a wide variety of information, often working under deadline pressure with a variety of levels of staff.

  • Strong project management skills.
  • Computer Skills: Smartsheet, Sharepoint, Microsoft Office (Word, Excel, PowerPoint), and database software.
Job ID: 50987
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