Navitus Health Solutions

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Accreditation Coordinator

at Navitus Health Solutions

Posted: 10/24/2017
Job Reference #: 5000270814706

Job Description

Requisition Number



Appleton Campus: Appleton, Wisconsin

Other Locations



High school diploma required with secondary education in healthcare or quality management desired. Intermediate to expert knowledge in MS Office including Visio, PowerPoint, and MS Project.  


2-3 years relevant experience desired. Experience in a pharmacy or PBM preferred. Experience in quality management experience preferred with knowledge of quality principles, URAC and NCQA standards and processes strongly desired. Previous project management experience helpful.

Job Description

The Accreditation Coordinator is responsible for coordinating Navitus' quality and compliance activities related to URAC accreditation, NCQA delegation agreements, and quality management program of Navitus Health Solutions and Lumicera Health Services. This includes Navitus' PBM and Lumicera's Specialty URAC accreditations. The Accreditation Coordinator understands the roles and responsibilities of the clinical and operational divisions as they contribute to the overall success of Navitus and is therefore able to coordinate process improvements within each division as it relates to the accreditations.  The Accreditation Coordinator is able to document potential improvements in a way that utilizes known quality assurance tools and proactively manages outcomes. This individual develops and maintains an expert understanding of URAC and NCQA standards and is responsible for proactive review of these regulations and guidance. This individual is responsible for mentoring employees in quality tools and concepts. The Accreditation Coordinator is responsible for Navitus and Lumicera quality program maintenance to include policy and procedure management, quality committee preparation and coordination, and accreditation document management. The Accreditation Coordinator position requires extensive document creation, maintenance, inventory control, and quality review and requires an extreme attention to detail and advanced written communication skills.  

Job Responsibilities:

·         Develops subject matter expertise in URAC PBM and Specialty standards, NCQA Health Plan delegated UM and Member portal (MEM) standards, and other regulations and guidance as applicable and the impact on either Navitus or Lumicera processes.

·         Coordinates preparation of the URAC accreditation application, maintains documentation to demonstrate compliance with accreditation standards and assists with on-site reviews.

·         Develops and maintains necessary Quality department policies and procedures to support URAC. Assures current policies and procedures comply with regulations and validates policies and procedures are in practice as written. Assists other departments with the same.

·         Provides NCQA support as needed to various Navitus departments regarding NCQA accredited health plan clients' requests.  

·         Executes audit processes to ensure Navitus and Lumicera remain compliant with accreditation standards.

·         Provides assessment of requirements to responsible areas when URAC or NCQA guidelines are revised and assists the responsible area in implementing changes required within required timeframes.

·         Coordinates work of quality committees and their respective Quality Improvement teams. Provides assistance and coordination for all quality activities driven by these teams.

·         Assists functional owners with data analysis including tracking, trending, and reporting as it pertains to quality improvement initiatives and maintenance of quality indicators.

·         Assists functional owners with documenting and managing action plans if processes do not comply with requirements, including timeframes and specific actions required for compliance.  

·         Assists with preparation of the annual Quality Management Program Descriptions and Work Plans and throughout the year coordinates reporting and monitoring of required elements within the Work Plan.

·         Assists with preparing the annual Quality Management Program evaluation for each Navitus and Lumicera.

·         Develop and provide quality improvement trainings to Navitus' staff to improve overall knowledge regarding quality processes, methodology, and URAC requirements.

·         Develops a solid working knowledge of Navitus' intranet site and other software applications that support URAC compliance and quality initiatives.

·         Assists in review and analysis of special projects and lead these projects as necessary.

·         Ability to travel between Navitus campuses 5 to 10% of the time and able to coordinate initiatives cross-campus via phone and videoconference.