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

Physical requirements:

• 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.