Director, NCQA Accreditation (Hybrid)

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week

• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week

• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

• Onsite: daily onsite requirement based on the essential functions of the job

• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This role requires work and residency within the state of Arizona.

PURPOSE OF THE JOB

• Develops, implements and oversees the Medicaid Segment of AZBLUE’s Accreditation Plan resulting in successful attainment of Accreditation. Develops and directs accreditation preparation activities and accrediting body reviews.
• Responsible for maintaining and ensuring all policies and procedures are up to date and in compliance with all accrediting and regulatory bodies for the Medicaid Segment to include NCQA, URAC, CMS and AHCCCS.
• Works collaboratively with the broader AZ Blue accreditation and quality teams to support reaccreditation and jointly operated health plans.
• Works collaboratively in a matrixed relationship with compliance and legal to insure all regulatory, compliance and legal requirements are met by the Medicaid Segment.
• Facilities and drives the completion of work requirements of all departments accountable for accreditation deliverables for the Medicaid Segment under the authority of the Medicaid Segments Chief Medical Officer and the entire Medicaid Segment’s leadership team.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

• 10 years of experience in the application of managed care practices
• 10 years of quality and management experience
• 5 years of accreditation experience
• 5 years of Medicare or Medicaid experience

2. Required Education

• Bachelor’s degree in a Health Service related field

3. Required Licenses

• Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a registered nurse (RN).

4. Required Certifications

• N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience ·

• 10 years’ experience in Quality Management , continuous quality improvement and outcomes reporting
• 3 years of experience in developing short and long range strategic plans, forecasting, and budgeting
• 5 years of experience in providing leadership to an established, sophisticated medical/health management division of a health insurance organization

2. Preferred Education

• Post-graduate education in Health Care Administration, Public Health and/or M.B.A.

3. Preferred Licenses

• N/A

4. Preferred Certifications

• Certified Specialist in Healthcare Accreditation (CSHA)
• Certified Professional in Healthcare Quality (CPHQ)

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

ACCREDITATION

• Develop and implement an Accreditation Program to include organization wide training and preparation for accreditation surveys, and ongoing readiness activities
• Coordinate and oversee regulatory activities to ensure integration and cohesion throughout accredited divisions
• Act as resource to staff and other departments in the area of accreditation and quality improvement
• Coordinate and submit applications, attestations, and required accreditatio