Accreditation and Delegation NurseLocation: Sacramento, CA (Hybrid)
Salary:$119,000-$135,000 AnnuallyPosition Type: Full-Time
Travel: Minimal
Western Health Advantage (WHA) is seeking an experienced
Accreditation and Delegation Nurse to support the management of our Quality Improvement Program and NCQA accreditation activities. This position promotes continuous performance improvement, supports regulatory and accreditation readiness, and serves as a trusted NCQA standards resource for internal departments and delegated Medical Groups.
The ideal candidate combines clinical knowledge, healthcare quality experience, analytical expertise, and strong project leadership skills.
What You'll Do- Provide leadership for projects supporting WHA's NCQA Health Plan and Health Outcomes accreditations.
- Help maintain year-round readiness for NCQA accreditation and DMHC regulatory surveys.
- Prepare reports and documentation, support onsite reviews, and coordinate post-survey follow-up activities.
- Conduct internal audits of required performance measures and supporting documentation.
- Communicate NCQA standards and provide guidance to key personnel on meeting accreditation requirements.
- Coordinate Quality Improvement projects by establishing indicators and methodologies, collecting and analyzing data, implementing interventions, and evaluating outcomes.
- Prepare member and provider materials and support systems and process-improvement activities.
- Track and trend project results, compile summary reports, and maintain complete project documentation.
- Collaborate with Medical Management, internal departments, delegated Medical Groups/IPAs, and Specialty Plans to support Quality Improvement Program goals.
- Oversee delegated functions by monitoring activities, reporting requirements, and opportunities for improvement.
- Ensure delegation agreements are updated as NCQA standards change and provide summary reports to the Quality Improvement Committee.
- Support readiness for recommendations issued by the DMHC Health Equity and Quality Committee.
- Assist with the development and revision of Quality Improvement Program documents, policies and procedures, quarterly and annual reports, and committee presentations.
- Serve as a member of the Quality Improvement Committee and chair other committees as assigned.
- Manage workflows to ensure project requirements and reporting deadlines are met.
- Perform additional duties and special projects as assigned.
What You'll Bring- Bachelor's degree in nursing or a healthcare-related field.
- A valid California Registered Nurse license before employment, which must be maintained throughout employment.
- At least four years of experience in healthcare quality, including Quality Improvement projects, medical record reviews, focused studies, and the management of complaints, grievances, or Potential Quality Issues.
- One to two years of experience participating in NCQA accreditation readiness; at least one year of survey experience is preferred.
- Certified Professional in Healthcare Quality certification is preferred.
- Experience using specialized software and electronic health record systems.
- Strong mathematical and analytical abilities, including demonstrated accuracy when tabulating data and calculating rates.
- Ability to identify data variations, analyze trends, evaluate processes, and present findings in clear reporting formats.
- Strong project management, organizational, communication, and collaboration skills.
