Major Purpose Of This Job: Responsible for assuring that day-to-day activities follow URAC policies and sound practice. Maintains overall responsibility for organization’s investigation approach for audits and reviews of accredited entities. Oversees compliance with the grievance process, auditing of accredited entities to ensure compliance with standards and notification of change activities. Conducts or manages specific investigations related to potential violations of accreditation and certification standards for Accredited Organizations, and supports investigations internal to URAC. Coordinates preparedness for conducting investigations of accredited entities and serves as a point of contact for inquiries related to implementation of grievance process and investigations related to suspension or revocation of accredited entities. Manager is responsible for drafting and preparing documents for various committees. Manager builds and maintains strong business relationships with leadership, staff, business partners to facilitate the overall accreditation and regulatory compliance strategies.
Job Duties And Responsibilities:
Determines the application of contracts with appropriate entities/corporations that are potential Applicants.
Oversees notification procedures and processes by Applicants, Accredited Organizations and URAC, including notice of change determinations.
Facilitates and conducts grievance investigations, findings, recommendations for action, communication and follow-up. Participates in HR investigations.
Provides consultation and technical support for Risk Management activities as they relate to findings of internal and external investigations and provides guidance and support for root cause analysis in the quality committee.
Serves as resource for staff on current external and internal process for investigating incidents as directed by Legal and Compliance.
Assures documentation of sensitive or confidential information related to investigations is accurate and up-to-date.
Prepares periodic management reports to include grievance investigations, complaints, with trends, patterns of occurrence, performance improvement. Provide ad hoc reports and recommendations as requested. Provides recommendations on process improvement to leadership and others.
Maintains URAC’s internal policies and procedures. In consultation with others, updates existing and prepares new policies and procedures as necessary.
Takes a leadership role on the Quality Committee.
Provides administrative and technical support for Boards and Committees, including attending meetings, coordination of agendas and preparation of minutes.
Assists General Counsel in preparing annual assessment of risks and risk mitigation to report to the governing board.
Education And Training Requirements:
Masters in a health-related field.
Professional license where required in a health related field.
Risk Management certification.
Certified in healthcare compliance a plus.
Three to five years of experience working in Risk Management or Compliance with relevant certifications.
Demonstrated strong writing skills, presentation and organizational skills.
Fully competent in word processing, power point and spreadsheet software.
Ability to read electronic and handwritten medical records.
Ability to travel as needed.
Ability to see and hear normal conversational tones.
Ability to sit for extended periods.
Ability to communicate effectively in writing and verbally.
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.
URAC is an equal opportunity and diversity employer. EOE, M/F/D/V.
Experience, Knowledge, And Skill Requirements:
The successful candidate should possess at least 3-5 years of Risk Management or Compliance related experience including foundational experience in conducting investigations.
The position requires a confident individual with a solid track record of independently managing a broad range of issues and interacting closely with business leaders.
Ideal candidate is an excellent writer, detail oriented, organized, responsive and deadline driven, adept at spotting issues and a pragmatic problem solver and a self-starter with the ability to work quickly and efficiently with limited supervision.
Ability to present review data in a clear, concise and organized manner.
Maintains records in an organized, confidential manner.
Exceptional communication and relationship building skills are essential.
Experience with health industry laws and regulation is a plus.
Internal Number: 1
URAC is an independent, nonprofit accreditation entity, based in Washington, DC, whose mission it is to advance healthcare quality through leadership, accreditation, measurement and innovation.