Senior Utilization Management Compliance and Accreditation Specialist

Delta Dental of Michigan

Leads compliance functions for Government Programs utilization management at Delta Dental. Ensures adherence to URAC/NCQA standards, audits, and quality improvement activities.

Posted 5/8/2026full-timeOkemos • Missouri • 🇺🇸 United StatesSeniorWebsite

About the role

Key responsibilities & impact

Leads the Government Programs utilization management (UM) compliance functions
Ensures adherence to URAC/NCQA standards
Drafts and maintains procedures, materials and reports for compliance
Analyzes and monitors UM and CR compliance metrics
Identifies potential compliance risks or barriers to maintaining URAC/NCQA accreditation
Supports regulatory and accreditation-related audits
Partners with department leadership to support compliance and quality goals
Participates in developing internal educational programs on compliance requirements
Maintains detailed project plans for URAC/NCQA standards monitoring
Oversees the URAC/NCQA survey process for utilization management

Requirements

What you’ll need

Bachelor's degree in business administration, public administration, or a related field
Seven years of experience in NCQA and/or URAC quality management or compliance auditing standards
General knowledge of federal and state laws, rules, and regulations
Strong verbal and written communication skills
Effective relationship building and interpersonal skills
Strong data analytical and problem-solving skills
Ability to use independent judgement to make decisions
Ability to multitask and work on multiple projects at any given time
Experience with Microsoft Office applications

Benefits

Comp & perks

Medical, dental and vision coverage
Short- and long-term disability
Life insurance
401(k) savings plans
Flexible spending accounts
Tuition reimbursement or educational assistance
Annual incentive compensation based on annual business goals
Eight hours of paid volunteer time each year
Access to an on-staff health coach and personal trainer
Many other perks

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Applicant Tracking System Keywords

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Hard Skills & Tools

compliance auditingutilization managementdata analysisproblem-solvingproject managementquality managementaccreditation standardsURAC standardsNCQA standardsregulatory compliance

Soft Skills

verbal communicationwritten communicationrelationship buildinginterpersonal skillsindependent judgementmultitaskingorganizational skillsleadershipcollaborationeducational program development