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Major purpose of this job: The Accreditation Reviewer is an expert in the content and interpretation of accreditation programs and standards. Primary responsibilities include analyzing accreditation application documentation and conducting validation reviews. Key additional responsibilities include participating in the standards development/revision process, providing educational instruction, and responding to inquiries related to interpretation of the accreditation standards.
Job duties and responsibilities:
Conducts all aspects of accreditation reviews, including:
Manages the client relationship as the primary point of contact for assigned applications
Communicates with applicants utilizing positive customer relation skills
Serves as a technical expert for accreditation program and standard content and interpretation
Conducts Desktop Review of applications including analyzing submitted documentation in accordance with URAC scoring methodology, providing constructive written feedback for areas of non-compliance and discussing findings with the applicants in an educational manner
Conducts onsite and/or virtual Validation Reviews
Documents and presents findings of applications to Accreditation Committees
Assists in providing technical support and advice to URAC Accreditation and Standards Committees including supporting the accreditation standards development/revision process
Assists in the development of program guides, educational workshop and webinar content, validation review tools, and other resources that facilitate consistent interpretation and application of program standards
Serves in the role of an educator for standards educational workshops and webinars
Assists in providing technical support for Research & Development, Sales & Marketing, and other URAC department as requested
Participates in the development, testing, and deployment of information support systems for the Accrediting & Client Services Department
Other duties as assigned
· Requires extensive travel (70-80%)
· Sedentary work in an office environment, moderate lifting (30 lbs. to 50 lbs.)
· Visually inspect surroundings, written materials and electronic media
· The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.
· Position requires Reviewers are entering health care facilities that mandate that the URAC Reviewer is vaccinated and updated on vaccines including COVID vaccine.
Experience, knowledge, and skill requirements:
Advanced reasoning, analysis, language ability (reading, writing and speaking)
Excellent written and verbal communication and presentation skills
Ability to communicate effectively and work collaboratively with colleagues, other healthcare professionals, clients and other stakeholders
Exceptional organizational skills
Ability to work independently
Strong negotiation, critical thinking, and problem-solving skills
Ability to handle conflict and to exercise sound judgment
Cognitive and interpersonal flexibility
Computer skills required include Windows Operating System Microsoft Software; Excel, Word, and PowerPoint
A valid US passport and valid driver’s license is required
Education and training requirements:
· For care management accreditation programs (i.e., utilization management, case management, health call center, and disease management) - registered Nurse with a bachelor’s degree in a health-related field (Master’s Degree preferred).
· Minimum of five (5) years of clinical experience and three (3) years of managed care experience to include one of the following: utilization management, case management, discharge planning, disease management, health call center, independent review, quality management, accreditation, or a related managed care function.
Licensure/Board Certification Requirements:
· A current license as a registered nurse in a state in the United States is required.
· For Case Management and Disease Management Accreditation, certification in case management is preferred.
URAC is a leader in promoting healthcare quality through its accreditation, education, and measurement programs. URAC's range of quality benchmarking programs and services model the rapid changes in the healthcare system and provide a symbol of excellence for organizations to validate their commitment to quality and accountability.