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Specialist, Accreditation and Regulation

Company: Somatus
Location: Oklahoma City
Posted on: March 16, 2023

Job Description:

??Regulatory Specialist, Accreditation and Regulation at SomatusRemote**Summary:**The Regulatory Specialist, Quality Accreditation and Regulations will be responsible for the day-to-day risk management activities for the organization, including investigating, managing, and analyzing risk management data, and complying with risk management-related standards for CMS, NCQA, and other accrediting agencies. This individual will be responsible for monitoring CMS regulations, NCQA standards, Model of Care (MOC) standards, and Standard of Work (SOW) to identify updates that need to be communicated.**Essential Duties and Responsibilities:**+ Serve as point of contact on CMS and NCQA standards and reporting requirements, coordinating and collaborating with regulatory bodies and business partners to ensure compliance with regulatory and quality of care service requirements+ Monitor and evaluate state program contracts and Medicaid regulatory requirements to inform program development and reporting needs+ Collaborate with quality, care management, and other teams on regulatory initiatives+ Develop work plans, timelines, and gap analysis to assess survey readiness for NCQA accreditation and state and federal-based quality improvement compliance requirements+ Maintain library of accreditation and regulatory updates from NCQA, CMS, and state regulators+ Identifies organizational risk through trend analysis of incidents, incident letters, reports, etc.+ Monitor SOW and ensure processes are in place to support requirements+ Partner, collaborate, develop and support Regulatory Specialists within the Clinical Operations-Quality, Audit, and Risk department as follows:+ Care management and regulatory initiatives+ Create and maintain audit tools, reports, standardized policies, procedures, and manuals+ Assess survey readiness for NCQA accreditation and state and federal-based quality improvement compliance+ QI compliance-related activities are accomplished each year+ Direct compliance issues to appropriate channels for investigation and resolution_P_ _lease note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice._**Required Education and Experience:**+ Bachelor's degree in Nursing or other related fields+ Two (2) years of experience with NCQA, CMS, and other regulatory bodies+ Experience in delegated Case and/or Care management+ Experience with Navex Global and/or EthicsPoint+ Experience with NCQA, CMS regulations, and accreditations+ Strong clinical background**Knowledge, Skills, and Abilities:**+ Possess an intermediate level knowledge of local, state, and federal laws and regulations on guidelines of provider and/or healthcare care management+ Ability to document and analyze complex business requirements and processes+ Strong analytical skills+ Ability to be both a strategic and tactical change agent in the healthcare space+ Self-starter who will take initiative and be proactive when there are multiple priorities+ Strategic solution-seeker who sees opportunities when others see barriers+ Strong interpersonal skills and ability to communicate effectively+ Ability to handle ambiguity and desire to work in a fast-paced start-up environment+ Detail-oriented, accurate and complete work timely+ Ability to communicate in a courteous and professional manner with teammates, leadership, vendors and others+ Proficient in MS Word, Excel, and Outlook**Travel Requirement:**+ This position may require up to 10 - 25% travel. Travel may be outside the local area and overnight.**Physical Requirements:**+ This job operates in a professional setting. While performing the duties of this job, the employee is regularly required to sit or stand for extended periods of time. Normal manual dexterity is required.+ Normal speaking and hearing abilities to interact with others in an office environment, over telephone or other video conferencing platform.+ The employee is occasionally required to stand; walk; and reach with hands and arms and continuously repeat the same hand, arm finger motion many times as in typing.Please note this job description is not designed to cover or?contain?a comprehensive listing of activities, duties or responsibilities that are?required of?the employee for this job. Duties,?responsibilities,?and activities may change at any time with or without notice.?**Our priority is the health and safety of our members, colleagues, partners, and community. Proof of COVID-19 Vaccination is required for employment. If you are unable to be vaccinated for medical reasons or sincerely held religious beliefs, we will consider requests for reasonable accommodations consistent with our policy, and where we are able to provide such accommodations without undue hardship to the company pursuant to applicable law.** ?_Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions_ ._Somatus, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law.? Further, the company takes affirmative action to ensure that applicants are employed, and employees are treated during employment without regard to any of these characteristics.? Discrimination of any type will not be tolerated._

Keywords: Somatus, Oklahoma City , Specialist, Accreditation and Regulation, Other , Oklahoma City, Oklahoma

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