Job Description
The Quality & Accreditation Specialist is responsible for coordinating and maintaining accreditation activities for the Utilization Management (UM) and Credentialing departments. This includes supporting NCQA accreditation, implementing quality monitoring initiatives, conducting internal reviews, and preparing reports. This role ensures that UM and Credentialing programs meet accreditation standards and achieve high-quality outcomes. The position will report to the Director of Medical Management and work closely with other departments to ensure program effectiveness and regulatory compliance.
JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES
The Quality and Accreditation Specialist’s responsibilities include but are not limited to:
- Coordinate all NCQA accreditation activities, including document preparation, maintenance of accreditation evidence, and survey readiness.
- Lead internal audit processes for UM and Credentialing, including planning, execution, data validation, documentation review, and reporting of findings.
- Support external audits as a shared responsibility with the Medical Management Operations team, including preparation, evidence collection, cross functional coordination, and follow up action plans.
- Develop internal audit tools, checklists, workflows, and monitoring structures to ensure ongoing compliance with NCQA, CMS, state, and health plan expectations.
- Monitor and analyze operational and data to identify trends, risks, and quality improvement opportunities.
- Implement and oversee quality monitoring initiatives to ensure continuous improvement and sustained accreditation readiness.
- Prepare reports and executive summaries of audit results, quality findings, and accreditation status updates for UM and Credentialing leadership.
- Educate and support UM and Credentialing staff on accreditation requirements, audit expectations, and quality standards.
- Partner with Medical Management operations teams and cross functional teams to resolve audit and accreditation related issues and maintain continuous readiness.
- Maintain up to date knowledge of NCQA standards, CMS/DOH requirements, and emerging accreditation or quality requirements.
- Perform other quality and accreditation related duties as assigned.
EDUCATION:
- Bachelor’s degree in health care administration, public health, or a related field.
- 3+ years of experience in quality improvement, accreditation, or a related field.
EXPERIENCE:
- Strong knowledge of NCQA accreditation standards, CMS, and state regulatory requirements.
- Experience conducting audits and preparing accreditation reports.
- Excellent written and verbal communication skills.
- Strong organizational skills with the ability to manage multiple accreditation activities simultaneously.
Salary: 75,000.00/Annually
Benefits Offered
- Competitive compensation and annual bonus program
- 401(k) retirement program with company match
- Company-paid life insurance
- Company-paid short term disability coverage (location restrictions may apply)
- Medical, Vision, and Dental benefits
- Paid Time Off (PTO)
- Paid Parental Leave
- Sick Time
- Paid company holidays and floating holidays
- Quarterly company-sponsored events
- Health and wellness programs
- Career development opportunities
Remote Opportunities
We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Vermont, and Washington.
Our Story
Founded in 2005, Integra Partners is a leading national durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) network administrator. Our mission is to improve the quality of life for the communities we serve by reimagining access to in-home healthcare. We connect Payers, Providers, and Members through innovative technology and streamlined workflows affording Members access to top local Providers and culturally competent care. By focusing on transparency, accountability, and adaptability, we help deliver better health outcomes and more efficient management of complex healthcare benefits. Integra Partners is a wholly owned subsidiary of Point32Health.
With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We’re looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you.
Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.
