Sr. Manager, Program and Project Management (NCQA Accreditation)

Your Role

The Senior Manager, Program and Project Management, NCQA Accreditation, is responsible for the coordination and execution of health plan wide accreditation activities, including both NCQA Health Plan and Health Equity Accreditation, and for coordinating with the Quality Governance team to ensure alignment on operational oversight activities, especially as related to regulatory survey preparation. This includes partnering with other operational leaders to ensure alignment of NCQA requirements with state/federal regulatory requirements, and other internal policies and procedures. In this role, you must be able to develop strong, collaborative relationships with internal stakeholders to meet quality and accreditation objectives. Additionally, the ability to work within large, multi-disciplinary teams to monitor milestones and deliverables, manage complex projects to projected completion dates, and to draw upon established relationships to build cross-functional teams that will achieve results are critical. This position reports to the Sr. Director, Health Operations Oversight.

Your Work

In this role, you will:

• Own all aspects of NCQA Accreditation (including ensuring collection, preparation, and accurate/timely submission/follow up as required). This includes but is not limited to preparing and submitting documents and files timely; collecting and preparing responses to auditors; and ensuring appropriate information is communicated to leadership/enterprise wide 
• Ensure required NCQA Health Plan Accreditation (HPA) and Health Equity Accreditation (HEA) are tracked and completed and/or gaps escalated to the Sr. Director of Health Operations Oversight and/or other accountable leaders timely
• Develop and maintain an ongoing survey readiness programs for NCQA through ongoing monitoring and tracking and report out of required activities (Blue Shield of California, Blue Shield Life & Health, and Blue Shield Promise Health Plan)
• Coordinate with NCQA consultant(s) to conduct mock surveys
• Ensure required documentation, data and action plans are collected from business owners, and as needed, prepared for submission timely
• Develop training programs for annual HPA and HEA accreditation updates and educational resource materials for staff, ensure training is conducted
• Partner with business owners to maintain a Health Equity training program that aligns with accreditation and regulatory requirements; collect proof that training is conducted annually and upon new hire
• Own all aspects of accreditation ensuring accurate and timely submission and follow-up as required
• Manage NCQA accreditation surveys (onsite or virtual), including collecting, preparing and submitting documents and files timely; arranging onsite logistics; serving as liaison with the audit team; collecting and preparing responses to auditors; and ensuring appropriate information is communicated to leadership and enterprise-wide, as applicable
• Manage corrective action plans required of accreditation audits and manage Accreditation staff and budget
• Contribute to process improvement across functions and within departments
• Work with cross-functional teams and upper management to ensure that key project deliverables are coordinated, and deadlines are met
• Develop reports for leadership to understand ongoing compliance, gaps and risks. Reports will need to align with Quality Governance team reporting standards

Your Knowledge and Experience

• Requires a college degree or equivalent experience
• Requires 10 years of prior relevant experience, including 4 years of management experience 
• Previous project & people management experience in multi-disciplinary setting 
• Lean Six Sigma and/or Agile experience is preferred
• Experience leading and managing NCQA accreditation survey process. DHMC, DHCS, CDI and Medicare Advantage experience is preferred
• Detailed understanding of NCQA HPA and HEA standards at a subject matter expert (SME) level
• Strong written and verbal communication skills with the ability to communicate effectively with senior leadership

 

#LI-JS3