Accreditation Specialist

Who We Are

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, you'll 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 $68,000 - $78,000, PLUS an annual performance-based, discretionary incentive.
  • *Compensation is dependent on non-discriminatory factors including but not limited to an applicant's skills, education/degrees, certifications, prior experience, market data, and other relevant factors.
• Comprehensive health benefit options: Medical, dental, and vision coverage
• 401(k) with competitive employer match
• Company-paid life and disability insurance
• Paid parental leave and wellbeing incentives
• Generous paid time off, including volunteer time
• Flexible spending accounts for healthcare and dependent care
• Professional development opportunities and tuition reimbursement
• Remote work flexibility (role-dependent)
• Opportunity for meaningful growth, both personally and professionally, where your unique background and experience is welcomed and valued.

At Lucet, your work will directly support our mission to improve behavioral, physical, and social health—one member at a time.

What You Will Do - Essential Functions

The Specialist, Accreditation ensures adherence to accreditation standards and regulatory requirements. This role involves coordinating and supporting accreditation audits, supporting 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 functional areas is essential to enhance operations and implement evidence-based guidelines. Additionally, the specialist will support staff training on accreditation requirements and best practices, serving as a liaison between internal departments to foster efficient and effective processes.

• Accreditation & Compliance
  
  • Support accreditation activities by preparing audit materials, maintaining documentation, and tracking performance metrics.
  • Monitor compliance with accreditation and managed care requirements (NCQA, URAC, Commercial, Medicare Advantage, Medicaid, Marketplace).
• Quality & Performance Monitoring
  • Collect, organize, and track utilization, network, case management, and quality performance data, including key KPIs.
  • Identify trends, investigate root causes, and escalate accreditation‑related performance gaps to leadership.
• Collaboration, Process Improvement & Training
  • Partner with UM, CM, quality, network, and credentialing teams to identify and document process improvement opportunities.
  • Support staff education, develop training materials, and assist with accreditation survey readiness and compliance reinforcement.

Who You Are

Required Qualifications

• Bachelor's degree in healthcare administration, nursing, or a related field.
• 3+ years of experience in case management, utilization review or auditing.
• 1+ 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.

Living our Values:

• 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) required.
• Frequent use of computer and phone systems
• Must be able to constantly remain in a stationary, sitting position, communicate and exchange information with others, inspect information, perform repetitive motions with arms and fingers, interpret data, problem solve, make decisions, organize and plan, and maintain a positive and professional attitude in all situations.

We encourage applicants from a variety of backgrounds and experiences to apply, especially those who can demonstrate how their unique qualifications and skills align with the requirements of this role and support our mission to improve whole-person health.

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.