Accreditation Specialist

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health.  For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience.  Our members are our neighbors, our friends, and our families.  It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. 

About the Role

This position will support Government Programs (GP) goal of improving quality of healthcare for our customers by ongoing monitoring of compliance with accreditation standards and regulatory requirements. This position will assist the Quality Management team in developing best practices for the coordination, facilitation, and oversight of all State and Federal accreditation activities..

What You'll Do

1. Manages ongoing accreditation activity for all Government Programs lines of business to maintain the highest level of accreditation, including monitoring of standards, conducting gap analysis, and developing action plans to address identified deficiencies.
2. Ensures that all updates to accreditation standards, changes to State contracts and changes to CMS regulations, which affect accreditation are communicated to relevant departments, develops action plans to address the changes, and monitors compliance.
3. Creates and manages multiple accreditation project plans with tasks coordinated across departments at all levels of the organization.
4. Assembles accreditation project teams and assigns individual task responsibilities.
5. Ensures a continuous state of readiness for ongoing accreditation surveys and annual assessments.
6. Monitors delegates compliance with accreditation standards in collaboration with the Delegation and Vendor Oversight Department.
7. Educate and support operational area representatives in regard to accreditation requirements.
8. Interface with key staff and consultant(s) involved in accreditation survey/audit preparations and on-site survey/audit processes.
9. Maintain electronic accreditation libraries, ensuring all documentation is accurate and current.
10. Plans, coordinates and facilities training for internal and external stakeholders on aspects of accreditation Responsible for coordination of workflows and assignments for external reviews.
11.Participate in internal and external meetings as needed.

What You Bring

Qualifications
Education/Experience:
Requires Bachelors degree from an accredited college or university, preferably in Healthcare Management, or related field.
Requires a minimum of 3 years of experience in accreditation or regulatory field, (i.e NCQA, URAC, etc.)

In lieu of degree applicant must have a combination of an additional 5 years of equivalent and relevant work experience in managed care, preferably Medicaid.

Additional licensing, certifications, registrations:
Knowledge:
1. Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint); Should be knowledgeable in the use of intranet and internet applications. including SharePoint and solid experience with Adobe

2. Requires knowledge of NCQA standards
3. Requires knowledge of state and federal regulations
4. Requires knowledge of managed care principles
5. Requires knowledge of project management.

Skills and Abilities:
1. Organizational and presentation skills
2. Communication skills, oral and written
3. Ability to prioritize and to multi-task in a fast-paced work environment.
4. Advanced planning and project management
5. Detail-orientation
6. Ability to plan and facilitate meetings.
7. Ability to effectively lead team members in diversified tasks
8. Priority setting and time management.

Travel % (If Applicable):
N/A
Scope of Accountabilities:
Add/Delete/Modify as appropriate:
- Supervise staff of
- Annual new business goals were usually in excess of $
- Operating budget of
- Client revenue responsibility of or more
- Claims approval authority:
- Maintain minimum quality scores of

12.12.22 Removed: "with a clinical or social certification or license"  from job description as directed by Kari Calello, HR (EP)

Why Horizon?

At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth.  We believe that when our people thrive, our communities do too.  If you are passionate about making an impact, we’d love to hear from you!

Salary Range:

$70,500 - $94,395

​This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.  This range has been created in good faith based on information known to Horizon at the time of posting.  Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Disclaimer:

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.  Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.