Job Description:

The PHM Accreditation Consultant manages the day-to-day activities, projects and initiatives that support Capitals’ health plan accreditation and PHM intervention/improvement strategy, as well as effectiveness evaluation.

The position requires solid project management and the ability to work collaboratively to raise awareness of current status and drive improvement projects to optimize overall accreditation efforts and intervention/improvement efforts.

This position’s primary responsibility is collecting and analyzing cross-functional activities to ensure compliance and close gaps to meet NCQA PHM accreditation standards. The consultant also provides oversight of our clinical vendors to ensure that the vendor is meeting PHM accreditation requirements.

Leadership:

• Ability to lead workgroups and bring groups to consensus.


• Ability to influence others to be accountable for assignments, improvement processes and drive performance excellence.

Skills:

• Ability to communicate effectively in verbal form.


• Proficient problem solving and critical thinking skills.


• Detail oriented and strong project management skills.


• Strong computer skills, must be proficient with Microsoft applications; Excel, Word, Visio, and PowerPoint


• Ability to effectively communicate in written form in order to prepare detailed reports that accurately convey the issue/problem/situation and recommended action in a clear and concise manner.

Knowledge:

• Knowledge of accreditation and/or regulatory standards such as; PA Department of Health, Department of Insurance, NCQA, CMS and HCR


• Knowledge of Population Health Management, Case Management, and Health and Wellness.


• Knowledge of insurance product offerings


• Knowledge of current and emerging industry trends in health care plans, accreditation and quality management practices

Experience:

• Minimum of 2 years of health plan/managed care experience


• Preferred knowledge of NCQA standards


• Preferred experience with project management techniques and process mapping/engineering

Education, certifications, and Licenses: 

• Associate degree required in a health related field and /or an active health care licensure


• Must maintain a valid Pennsylvania driver’s license.

Capital BlueCross is an independent licensee of the BlueCross BlueShield Association. We are an equal opportunity/affirmative action employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law. 

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