Location: US Locations Only; 100% Remote US
Major purpose of this job:
Conducts specific investigations related to potential violations of accreditation and certification program standards by accredited organizations. Serves as a point of contact for inquiries related to implementation of grievance process and investigations related to suspension or revocation of accredited entities. Provides initial onboarding orientation and ongoing training for all Reviewers.
Job duties and responsibilities:
- Maintains up-to-date knowledge of all accreditation and certification program standards and the current accreditation review process for programs.
- Responsible for investigating grievances to resolution to include documentation of findings, recommendations for action, communication, and follow-up.
- Collaborates with the Directors of Care Management and/or Pharmacy to adjudicate grievances as needed.
- Assures documentation of sensitive or confidential information related to investigations is accurate and up to date.
- Provides program updates, prepares grievance and complaint investigations reports and provides ad hoc reports as requested.
- Provides recommendations on process improvement to leadership and others.
- Maintains URAC’s internal policies and procedures. In consultation with others, updates existing and prepares new policies and procedures as necessary.
- Provides accreditation and/or certification program standards interpretation as assigned.
- Conducts desktop reviews and validation reviews as requested.
- Participates in interrater reliability testing.
- Assess training needs for development of new training programs and/or modifications for improvement and consistency with existing programs. This includes onboarding, annual updates, program specific standards training (new, revised), accreditation assessment and scoring, systems use and conduct of validation reviews (desktop, on site, virtual).
- Develops, implements, and evaluates training tools and instructional materials for new and existing employees.
- Identifies and assesses current and future training needs of Accrediting and Client Services.
- Performs other duties as assigned.
Physical requirements:
- Sedentary work in an office environment, moderate lifting (30lbs-50lbs).
- Ability to verbally convey ideas clearly and quickly, receive, process and understand complex materials.
- Ability to visually inspect surroundings, written materials and electronic media.
- Business travel as needed with occasional overnight stays.
- The physical demands and work environment that have been described is representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.
- Position requires Reviewers are entering health care facilities that mandate that the URAC Reviewer is vaccinated and updated on vaccines including COVID vaccines.
Experience, knowledge, and skill requirements:
- Ability to analyze grievance/complaint issue(s) with applicability to standards
- Ability to mediate between Grievant and Point of Contact as related to compliance of standards
- Experience analyzing department needs for training and lesson planning development, and implementation.
- Experience developing training plans and materials.
- Ability to effectively organize and manage multiple training initiatives simultaneously.
- Excellent written and verbal communication and presentation skills.
- Ability to communicate effectively and work collaboratively with colleagues, other healthcare professionals, clients, and other stakeholders.
- Exceptional organizational skills.
- Ability to work independently.
- Strong negotiation, critical thinking, and problem-solving skills.
- Ability to handle conflict and to exercise sound judgment.
- Proficient in Microsoft Office (i.e. Excel, Word, and PowerPoint).
- A valid US passport and valid driver’s license is required.
Education and training requirements:
- Registered Nurse with a bachelor’s degree in a health-related field (Master’s Degree preferred).
- Minimum of five (5) years of clinical experience and three (3) years of managed care experience to include one of the following: utilization management, case management, discharge planning, disease management, health call center, independent review, quality management, accreditation, or a related managed care function.
- Experience as a program standards Reviewer or Auditor.
- Minimum of 5 years of experience with designing training programs and workshops.
- Knowledge of various training and teaching methods.
OR
- A Doctor of Pharmacy (PharmD) or Bachelor’s degree in Pharmacy.
- A minimum of three (3) years of pharmacy practice experience. Specialty pharmacy and/or managed care pharmacy experience preferred.
- Minimum of 5 years of experience with designing training programs and workshops.
- Knowledge of various training and teaching methods.
Licensure/Board Certification Requirements: A current license as a Registered Nurse or Pharmacist in a state in the United States is required. · Professional certification, such as Certified Professional in Training Management (CPTM) and Project Management Professional (PMP), is a plus.
Location: US Locations Only