What are the responsibilities and job description for the HEALTH PLAN ACCREDITATION PROGRAM MANAGER, HEALTH PLAN SERVICES position at Cook County Health & Hospitals System?
The final salary and offer components are subject to additional approvals based on Cook County Health (CCH) policy. Your placement within the salary range is dependent on a number of factors including your work experience and internal equity within this position classification at CCH. For positions that are represented by a labor union, placement within the salary range will be guided by the rules in the collective bargaining agreement.
LOCATION: Health Plan Services
SHIFT: 8:30AM – 4:30PM
Job Title
Health Plan Accreditation Program Manager
Department
CountyCare
This position is exempt from Career Service under the CCH Personnel Rules.
Job Summary
Under the direction of the Director of Program Management and Performance Excellence, directs the strategic management and planning of the National Committee for Quality Assurance (NCQA) Health Plan Accreditation process for the CountyCare Health Plan, Cook County Health (CCH) Medicaid managed care health plan. Sets guidelines to meet the NCQA accreditation requirements leading to successful accreditation for the health plan. Develops and maintains a comprehensive accreditation project plan adhering to the standards, quality studies, prioritized interventions and on-going monitoring for compliance as established by NCQA for all accreditation requirements. Coordinates the efforts to earn outstanding clinical performance and a positive customer experience as required for accreditation.
General Administrative Responsibilities
Collective Bargaining
- Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
- Participate in collective bargaining negotiations, caucus discussions and working meetings
Discipline
- Document, recommend and effectuate discipline at all levels
- Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements
- Initiate, authorize and complete disciplinary action pursuant to CCH system rules, policies, procedures and provision of applicable collective bargaining agreements
Supervision
- Direct and effectuate CCH management policies and practices
- Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements
Management
- Contribute to the management of CCH staff and CCH’ systemic development and success
- Discuss and develop CCH system policies and procedures
- Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements
- Work with Labor Relations to discern past practice when necessary
Typical Duties
- Establishes set guidelines to meet NCQA accreditation requirements
- Develops and leads a regulatory survey readiness program planning process in support of the organization's mission, values and business objectives
- Works with health plan leadership, CCH senior management, clinical, network and operational staff in leading and managing all aspects of the accreditation process and standard adherence
- Conducts training and coaching to support understanding of accreditation standards and requirements
- Develops and maintains a comprehensive project plan linked to standards with on-going monitoring and reporting to health plan leadership and CCH senior management as necessary
- Understands the relationship between NCQA and Centers of Medicare and Medicaid (CMS) as it relates to specific NCQA Accreditation requirements
- Develops and revises policies and procedures to comply with NCQA guidelines and regulatory standards
- Coordinates activities with subject matter experts (SME) and unit business owners
- Facilitates communication of information among governance committees and serves as SME on accreditation issues and changing standards
- Develops and manages audit activities to ensure accreditation compliance such as department wide on-site surveys
- Participates in program management, analysis and evaluation of the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys
- Coordinates member and provider input as needed for accreditation purposes working with vendors and auditors
- Maintains accreditation and audit document library
- Must be able to work flexible hours
- Must be able to travel throughout Cook County
- Performs other duties as assigned
- Minimum Qualifications
- Bachelor's degree from a four-year accredited university is required (Official transcript is due at the time of interview)
- Three (3) years of experience in a Medicare Managed Care Organization (MCO) or Medicaid MCO in a large hospital or healthcare system is required
- Two (2) years of experience with accreditation and regulatory survey process, development, and follow-up of corrective plans is required
- One (1) year of program management experience is required
- Proficiency using Microsoft Office (Access, Excel, Word and PowerPoint) is required
- Must be able to travel throughout Cook County is required
Preferred Qualifications
- Experience in developing and implementing an accreditation plan in a healthcare environment is preferred
- Experience implementing accreditation standards for a Managed Care Organization (MCO) such as Medicaid MCO is preferred
- Experience in leading a broadly integrated process related to achieving accreditation standards is preferred
- Successful completion of the NCQA accreditation process resulting in a fully accredited designation is preferred
Knowledge, Skills, Abilities and Other Characteristics
- Knowledge of trends in health care in general, especially underserved populations
- Knowledge of CountyCare health plan
- Knowledge of governmental and other regulatory standards, requirements and guidelines related to quality improvement such as NCQA, CMS and Joint Commission
- Proficiency using Microsoft Office (Access, Excel, Word and PowerPoint)
- Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups
- Excellent program development, management and leadership skills
- Strong customer service and empathy skills
- Strong interpersonal skills to build relationships, negotiate and collaborate with individuals, organizations and stakeholders
- Demonstrate good phone and email etiquette skills with strong response times
- Demonstrates good computer and typing skills
- Demonstrate analytical and organizational, problem-solving, critical thinking and conflict management/resolution skills
- Demonstrate attention to detail, accuracy and precision
- Demonstrate a strong initiative to innovate, improve health outcomes for individuals and populations and implement integration of behavioral and physical health care
- Ability to conduct activities in accordance with CCH privacy policies and provide leadership to the Plan and organization regarding confidentiality requirements for behavioral health services
- Ability to train by presenting concepts and demonstrating tasks
- Ability to work flexible hours
- Must be able to travel throughout Cook County
- Ability to prioritize, plan and organize projects and tasks
- Ability to multi-task and meet deadlines in a fast paced and stressful environment
- Ability to maintain a professional demeanor and composure when challenged
- Ability to function autonomously and as a team member in a multidisciplinary team
VETERAN PREFERENCE
PLEASE READ
When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service
To take advantage of this preference a Veteran must:
- Meet the minimum qualifications for the position.
- Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, “Are you a Military Veteran?”
- Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable
OR
- A copy of a valid State ID Card or Driver’s License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing.
If items are not attached, you will not be eligible for Veteran Preference
VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER’S LICENSE AT TIME OF INTERVIEW.
MUST MEET ALL REQUIRED QUALIFICATIONS AT TIME OF APPLICATION FILING
BENEFITS PACKAGE:
Medical, Dental, and Vision Coverage
Basic Term Life Insurance
Pension Plan
Deferred Compensation Program
Paid Holidays, Vacation, and Sick Time
You may also qualify for the Public Service Loan Forgiveness Program (PSLF)
100% Tuition Reimbursement for nursing-related programs
For further information on our excellent benefits package, please click on the following link: http://www.cookcountyrisk.com/
Department of Risk Management
Degrees awarded outside of the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U.S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview.
- Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen.
- CCHHS is strictly prohibited from conditioning, basing or knowingly prejudicing or affecting any term or aspect of County employment or hiring upon or because of any political reason or factor.
COOK COUNTY HEALTH IS AN EQUAL OPPORTUNITY EMPLOYER
Salary : $113,220 - $134,538
