Accreditation and Quality Manager

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Learn more at: https://prominence-health.com/

Job Summary:

The Accreditation and Quality Manager designs, implements, and facilitates a systematic approach to ensure the effectiveness of quality assurance and accreditation programs. This position serves as an individual contributor and subject matter expert for Prominence Health and is responsible for strategic planning and day-to-day management of the quality assurance and accreditation programs. This position works closely with the Chief Medical Officer and other operational leaders. The role is responsible for training, quality reporting, committee activities, root cause analyses, implementation of corrective actions, and the monitoring and auditing of the performance of the quality assurance and accreditation programs. This role will serve as the primary point of contact with the health plan’s accreditation agency and represent the quality program with regulatory agencies to ensure quality, accreditation and regulatory requirements are met or exceeded. This position reports to the Vice President of Health Services.

About Universal Health Services:

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Qualifications and Requirements:

• Bachelor’s degree in business administration, healthcare administration, public health, nursing, organizational development or other related field; Master’s degree preferred. Equivalent combination of experience will be considered in lieu of education.
• Active, unrestricted, current and valid Registered Nurse (RN) highly preferred
• Quality, performance improvement, or project management certification preferred.
• Experience with URAC 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.
• Minimum of five (5) years’ demonstrated success with quality improvement, accreditation, risk management, organizational development, compliance, administrative and/or operations in health care, preferably in a management role in a managed care organization.
• Ability to effectively communicate in English, both verbally and in writing.
• 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 include analyzing risk assessments, performing audits, corrective action, 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.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

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At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS

and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.