apree health Careers

Description

Director of Accreditation Oversight

The Director of Accreditation Oversight will be responsible for the subject matter expertise of all of the solution work needed to support a Medicare line of business.  This includes contributing to the requirements and scope for new solution development as well as ensuring that our clinical operations are meeting the needs of this line of business.

This director is a collaborative leader. As an individual contributor, they will work cross-functionally with multiple stakeholder teams including clinical services, R&D, compliance professional services, client services, sales as well as up and downstream marketing.  This person needs to be able to manage executive level communication through regular well-informed status updates that tie the work to outcomes and KPIs. This person will regularly manage feedback loops, both external and internal and use this feedback to drive solution advancements.  Feedback loops will also inform internal team education and meetings.

The preferred candidate will be a problem solver who thrives working across healthcare, technology, and data domains.  Someone who is able to take regulatory requirements and translate them into operational policies and procedures. This person will work closely with program and clinical leadership to ensure workflows, documentation standards, and patient facing solutions meet the requirements. The candidate will have experience working in tech-enabled healthcare services, population health management, or a health tech organization and possess strong analytical and communication skills.  This person has a broad understanding of major healthcare regulatory initiatives like Meaningful Use and 21st Century Cures Act and how these regulatory mandates impact primary care and care management.  The ideal candidate will enjoy problem solving, have a growth mindset, and be able to drive progress independently. 

This candidate will have extensive experience with operationalizing NCQA, CMS or other governing body’s requirements and translating them to meaningful and compliant care.

Responsibilities

• Strategic Leadership: Develop and execute a comprehensive strategic plan to get apree’s RN Care Management program NCQA certified, aligning with company goals and industry best practices.
• Accreditation Oversight: Review existing clinical programs and identify opportunities for certification, helping bring regulatory rigor to our existing clinical excellence. 
• Compliance and Regulatory Adherence: Stay updated and ensure full compliance with relevant regulations, policies, and guidelines, mitigating any risks associated with non-compliance.
• Product lifecycle management:  Lead product initiatives for the person and care team personas that support the regulatory .  Ensure robust and streamlined product documentation is completed.  Continuously monitor product market positioning against established KPIs and OKRs.
• Education: Conduct education sessions for apree staff on accreditation standards and regulatory requirements for relevant governing bodies and health plan standards. 
• Stakeholder Management:  Communicate with a wide-range of internal and external stakeholders throughout the product life cycle
• Product Leadership:  Demonstrate leadership and creativity on complex projects and show foresight through translation of significant market needs to product roadmaps that drive outcomes.
• Product Development Collaboration:  Partner closely with both on-shore and off-shore development teams, R&D leadership, and data/technology partners to drive end-to-end product development cycles
• Strategic thinking:  Demonstrate a creative and strategic mindset with the ability to think outside the box and envision groundbreaking solutions.
  
  

• 8+ years of progressive experience in healthcare administration, with a focus on regulatory requirements from CS, NCQA, HHS, and other governing bodies. 
• NCQA or Centers for Medicare and Medicaid (CMS) Program audit experience 
• Familiarity with Project Management tools and techniques  
• Experience with establishing a Clinical Compliance Oversight Program that satisfies the overall Enterprise Compliance Program Effectiveness strategy
• 5+ years Clinical experience preferred
• Familiarity with HEDIS and STAR quality measures, risk stratification, and CAHPSrequired
• Familiarity with National Committee for Quality Assurance (NCQA)
• Familiarity with Contractual negotiation specific to Medicare Compliance  
• Medical writing experience preferred
• Bachelor’s degree or master’s in relevant field required,  business/economics,leadership,, communications, healthcare administration 
• Proven leadership and managerial experience, with a track record of successfully leading teams and achieving departmental goals.
• Exceptional knowledge of policies, procedures, and compliance requirements of government regulatory bodies.
• Strong business acumen and intellectual curiosity - ability to approach complex business problems in a logical, structured way and drive rapidly toward innovation
• Excellent communication, leadership and interpersonal skills
• Comfortable with a fast-paced environment and willingness to be flexible and pivot when needed
• Travel likely required 2-3 days quarterly.
  
  

• Requires being at a desk for extended periods of time
• Manual and finger dexterity and eye-hand coordination 
• Requires standing, walking and sitting for extended periods of time
• Occasionally lift and carry items up to 50 pounds
• Requires corrected vision, hearing and speech within normal ranges 

Compensation:  $147k-$210k/annual salary & bonus eligible (national average, premium markets may vary)