Director, Accreditation & Delegation Oversight

Director, Accreditation & Delegation Oversight

MOBE helps people discover new ways to live healthier. We are the whole‑person, cross‑condition solution that goes further to deliver better health and lower overall costs through evidence‑based individual health guidance and pharmacist‑led medication management. Behind our innovative solutions are robust data analytics, digital application, and a uniquely human philosophy.

MOBE guides people to better health and more happiness. We help people discover connections between aspects of their lifestyle that affect health and well‑being, including their medications and supplements. We value a workforce made up of people with differences who are eager to learn from each other and grow personally and professionally.

• Own MOBE’s NCQA accreditation lifecycle for the Complex Care Management program – including readiness assessments, gap analyses, file reviews, evidence collection, mock surveys, and on‑site or virtual survey execution – ensuring continuous compliance with all applicable NCQA standards (CM 1–CM 9 and supporting standards).
• Build, lead, and continuously mature MOBE’s delegation oversight program for delegated functions performed on behalf of health plan partners – including pre‑delegation assessments, annual audits, ongoing performance monitoring, corrective action plan (CAP) management, and routine reporting to delegating entities.
• Serve as MOBE’s primary external contact for NCQA surveyors and for delegating health plan oversight teams; coordinate document requests, file pulls, walkthroughs, and corrective responses with professionalism and speed.
• Chair MOBE’s internal Accreditation & Delegation Oversight Committee; set the agenda, drive cross‑functional accountability, document decisions, and elevate risks to executive leadership when warranted.
• Translate NCQA standards, delegation agreements, and regulatory requirements into clear policies, procedures, workflows, training, and audit tools that frontline clinical and operational teams can use every day.
• Design and oversee a robust file review program covering Complex Care Management cases, including inter‑rater reliability, sampling methodology, scoring, root‑cause analysis of findings, and remediation tracking.
• Partner with Clinical Operations and Care Management leadership to operationalize evidence‑based clinical criteria, member rights and responsibilities, complex case management workflows, transitions of care, and population health management activities in line with NCQA expectations.
• Produce monthly and quarterly delegation oversight reports for health plan partners; lead joint operating committee (JOC) preparation, presentation, and follow‑up commitments.
• Monitor regulatory and accreditation changes (NCQA, CMS, state Medicaid agencies, URAC where applicable) and lead MOBE’s response – including impact analysis, policy updates, and stakeholder communication.
• Build and lead a small but high‑performing accreditation and delegation oversight team; hire, coach, and develop analysts and specialists as the program scales with new client commitments.
• Partner with Compliance, Privacy, and Information Security to maintain alignment across HIPAA, member confidentiality, information security controls, and member rights requirements that intersect with accreditation standards.
• Champion a culture of continuous quality improvement – using data, trend analysis, and member experience insights to drive measurable program improvements year over year.
• Strong analytic and project‑management discipline; able to manage multiple concurrent audit cycles, document requests, and CAPs without dropping commitments.

Required

• Bachelor’s degree in nursing, health administration, public health, quality, or a related field.
• Minimum 8 years of progressive experience in healthcare quality, accreditation, or delegation oversight, with at least 3 years leading an NCQA accreditation or re‑accreditation effort.
• Deep, current working knowledge of NCQA Case Management / Complex Care Management standards and the survey process; demonstrated success serving as a primary point of contact during a…