Job description

Create Your Career With Us!

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

Facility: Cherapa Place Building

Location: Sioux Falls, SD

Address: 300 N Cherapa Pl, Sioux Falls, SD 57103, USA

Shift: 8 Hours - Day Shifts

Job Schedule: Full time

Weekly Hours: 40. 00

Salary Range: $21.50 - $34.50

Job Summary

The Quality and Accreditation Specialist serves as the Accreditation and QI Subject Matter Expert to internal and external stakeholders across a specified line of business and quality programs (Medicare Advantage, Medicaid, Commercial, and government and commercial payer partnerships). Proactively develops quality activities aligned with company strategies and values. Facilitates and/or participates in multi-department/cross-functional committees and work groups that support key QI and Accreditation initiatives. Monitors compliance of all programs to ensure alignment with standards and business initiatives. Possesses knowledge of quality management and performance improvement principles. Possesses knowledge of accreditation standards and processes. Excellent written and oral communication skills. Provides internal stakeholders and measure lead guidance and interpretation of accreditation standards via assessment of programs, gap analysis, quantitative and qualitative analysis. Proposes corrective action plans, policy and workflow revisions and QI performance improvement projects/initiatives to improve outcomes. Presents corrective action plans and related status to leadership and facilitates QI meetings as necessary. Collaborates with internal and external stakeholders to ensure HEDIS and CAHPS initiatives are fully integrated throughout the organization, maximizing opportunities to improve outcomes for members. Collects, reviews and extracts documentation for medical record review. Completes ongoing review of records submitted by providers and the annual HEDIS medical record review. Research claims history to determine most appropriate and likely source of necessary documentation. Work with providers to secure the medical records. Based on a strong knowledge of HEDIS criteria identify the medical information that supports the specific HEDIS measure. Facilitates provider outreach to ensure member receipt of important clinical services to improvement member health outcomes.

Qualifications

Bachelor s degree in quality management, healthcare related field, or management is required.

Minimum of two years experience is preferred.

Certified Professional in Healthcare Quality (CPHQ) is preferred.

Benefits

Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, sick leave and paid time off. To review your benefit eligibility, visit https://sanfordcareers.com/benefits .

Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .

Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.

Req Number: R-0111329

Job Function: Health Plan

Featured: No

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