Senior Accreditation Specialist

Company: New Directions Behavioral Health
Location: San Diego
Posted on: January 4, 2026

Job Description:

At Lucet, we are industry leaders in behavioral health, dedicated to helping people live healthy, balanced lives. Our purpose is to advocate for and improve the overall well-being of those we serve, through balanced treatment of the mind and body. When you join Lucet, you become a valued member of our team, serving more than 15 million people across the U.S. Our employees have a passion for helping others - and it shows. From entry-level employees to senior leaders, we are inspired by our members, putting them first in everything we do. From day one, youll see firsthand the impact you have on our members, knowing you can make a true difference in their lives. Why join our team at Lucet? We are a team of collaborative and hard-working professionals working to improve behavioral health outcomes working in a fast-paced and changing environment. At Lucet, no two days are the same. If you find joy in meaningful work and delivering excellent results, we encourage you to apply! We are looking for top-tier skills and experience in our remote-work environment and that’s because we offer top-tier compensation and benefits, which include: Annual compensation between $77,000 - $87,000, PLUS an annual performance-based, discretionary incentive. Compensation is dependent on non-discriminatory factors including but not limited to an applicants skills, education/degrees, certifications, prior experience, market data, and other relevant factors. Health Insurance – $0 premium for employee-only coverage in our core program for those participating in our Wellbeing Incentive Program. 401(k) with competitive employer match Company paid life and disability insurance, wellbeing incentives, and parental leave Professional development opportunities and tuition reimbursement Paid time off including paid time off for volunteering Opportunity for meaningful growth, both personally and professionally, where your unique background and experience is welcomed and valued. What You Will Do - Essential Functions The Senior Specialist, Accreditation ensures adherence to accreditation standards and regulatory requirements. This role involves coordinating and supporting accreditation audits, developing action plans to address compliance gaps, and maintaining comprehensive documentation. The specialist will monitor utilization management (UM) and case management (CM) activities, analyze data, and report key performance indicators to ensure quality and compliance. Collaboration with clinical and administrative teams is essential to enhance operations and implement evidence-based guidelines. Additionally, the specialist will educate and train staff on accreditation requirements and best practices, serving as a liaison between internal departments to foster efficient and effective processes. Accreditation and Compliance Ensure compliance with accreditation standards (NCQA, URAC) and regulatory requirements by maintaining current knowledge, updating policies, and supporting audits and surveys. Conduct clinical and compliance audits, track performance metrics, compile findings, and report trends to management to address gaps and improve processes. Develop, review, and implement policies and procedures for clinical compliance, quality, utilization management, and behavioral health integration while ensuring adherence to all payer guidelines. Quality and Performance Monitoring Monitor utilization management (UM) and case management (CM) activities to ensure compliance with accreditation and quality standards, analyzing data and generating reports. Track and report key performance indicators (KPIs) for utilization review, appeals, denials, and case management efficiency to assess compliance and performance. Identify trends and provide actionable insights to leadership on accreditation-related performance and improvement opportunities. Collaboration and Process Improvement Collaborate with clinical, administrative, and cross-functional teams to enhance utilization and case management operations, serving as a liaison between key departments. Recommend and implement process improvements for compliance and efficiency; identify cases requiring intervention for over- or under-utilization of behavioral and medical resources. Develop and execute action plans to resolve issues and support operational and accreditation goals. Education and Training Educate and train staff on accreditation requirements, utilization management (UM), case management (CM), and best practices for compliance and documentation. Provide ongoing education on clinical coding, evidence-based practices, and cost containment strategies to ensure quality and regulatory adherence. Support accreditation surveys and maintain staff readiness through continuous training on standards and procedures. Adhere to Lucet’s Mission Statement, Core Values, Behaviors, Code of Ethical Business Conduct, and Compliance Program. Comply with all Federal and applicable State and local laws and Lucet Policies and Procedures regarding privacy, confidentiality, and security of health information, and other designated information. Who You Are Required Qualifications Bachelors degree in healthcare administration, nursing, or a related field. Active clinical license (RN, LCSW, LPC, etc) 5 years of experience in case management, utilization review or auditing. 3 years of experience in a managed care environment Experience with NCQA, URAC, CMS, or Joint Commission accreditation standards Microsoft office and Excel spreadsheet manipulation knowledge/experience Ability to pass background check upon hire and throughout employment to include criminal felony & misdemeanor search, SSN validation/trace search (LEIE), education report (highest degree obtained), civil upper and lower search, 7-year employment report, federal criminal search, statewide criminal search, widescreen plus national criminal search, health care sanctions-state med (SAM), national sex offender registry, prohibited parties (OFAC) (terrorist watchlist), and a 10-Panel Drug Screen. Preferred Qualifications Master’s Degree Certified Case Manager or Certified Professional in Healthcare Quality (CPHQ) Medicaid and Medicare knowledge Someone who embodies our values by: Serving everyone with compassion and leading with empathy. Stepping up and creating value by taking charge and acting when there is an opportunity. Adapting in a changing world by recognizing our responsibility to be agile and respond quickly. Nurturing growth and belonging by respecting and celebrating everyone for who they are. Competencies Attention to Detail: Ability to meticulously review and audit medical records for accuracy and compliance. Analytical Skills: Strong capability to identify discrepancies and non-compliance issues in documentation. Communication Skills: Effective in liaising with healthcare providers and internal teams, and in educating staff. Regulatory Knowledge: In-depth understanding of Commercial, Medicare, Medicaid, and private insurance guidelines. Problem-Solving: Proficient in developing action plans and recommending process improvements. Training and Education: Skilled in providing training on documentation best practices, compliance standards, and utilization management. Working Conditions: Work is performed from home with company-provided equipment. Sitting for long periods of time is expected and use of fingers and hands for typing is necessary. A quiet workspace with minimal background noise for calls. High-speed internet service (cable or fiber optic) with minimum download Speed of 20 Mbps, Upload Speed of 5 Mbps, and Maximum Latency of 100 milliseconds (must be installed before starting). Work is performed from home with company-provided equipment. Sitting for long periods of time is expected and use of fingers and hands for typing is necessary. A quiet workspace with minimal background noise for calls. We encourage applicants with a range of experiences who can demonstrate how their qualifications and skills align with the requirements of this role. This position will accept and review new applications and resumes no less than 5 business days after the original posting date and may remain open an extended period of time with no set end date based on the level of interest. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

Keywords: New Directions Behavioral Health, San Diego , Senior Accreditation Specialist, Healthcare , San Diego, California