Provide remote consulting support for health plans preparing for NCQA accreditation, focusing on gap analysis, readiness assessments, file review, documentation development, and staff coaching. The work centers on accreditation preparation across commercial, Medicaid, Medicare, and Marketplace lines of business, with possible involvement in related NCQA products such as health equity, population health, UM accreditation, QI, and case management. This is a 1099 contract role with independent, billable-hour work and no travel required.
Key Responsibilities
- Conduct documentation reviews against NCQA standards and identify compliance gaps.
- Provide coaching, mentoring, and training to client staff, managers, directors, and executives.
- Develop or refine survey readiness strategies, work plans, and documentation needed for accreditation submission.
- Review health plan files, including appeals, denials, complex case management, credentialing, and recredentialing records.
- Facilitate workgroup meetings and help clients address barriers to meeting standards.
- Support project management activities and coordinate priorities across multiple client assignments.
- Use Microsoft Office, Adobe tools, and web-based systems to prepare and organize accreditation materials.
Required
- At least two recent cycles of hands-on experience taking health plans through NCQA health plan accreditation.
- Direct experience evaluating documents against NCQA standards and preparing submission materials.
- Experience reviewing health plan accreditation files across commercial, Medicaid, Medicare, and Marketplace lines of business.
- Strong analytical skills, critical thinking, attention to detail, and ability to work independently.
- Bachelor’s degree in Healthcare Administration, Public Health, or a related field, or RN license for clinicians.
- Ability to pass a background check and provide three references.
Preferred
- Current NCQA surveyor experience.
- Master’s degree in health services, public policy, health services administration, or business.
- Experience with additional NCQA products such as health equity, population health programs, UM accreditation, QI, or case management accreditation.
- Experience with credentialing, quality improvement, network management, or member experience for non-clinicians.
Benefits & Perks
- Remote work with no travel required.
- Flexible billable-hour range of 20 to 32 hours per week.
- Formal onboarding, orientation, and collegial mentoring support.
- Independent 1099 consulting arrangement.
- Opportunity to focus strictly on accreditation preparation.