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

Job Description

Your Role

The Senior Program Manager, 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. They must be able to develop strong, collaborative relationships with internal stakeholders to meet quality and accreditation objectives. The individual in this role must be able to work within large, multi-disciplinary teams to monitor milestones and deliverables, manage complex projects to projected completion dates, and draw upon established relationships to build cross-functional teams that will achieve results. This position reports to the Director of Quality Assurance.

Responsibilities

Your Work

In this role, you will :

• Be accountable for 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.
• Be accountable for ensuring required NCQA Health Plan Accreditation (HPA) and Health Equity Accreditation (HEA) are tracked and completed and / or gaps escalated to the Director Quality Assurance 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.
• Accountable for 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

Qualifications

Your Knowledge and Experience

Pay Range :

The pay range for this role is : $ 136400.00 to $ 204600.00 for California.

Note :

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

About the Team

Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!

Our Values :

Our Workplace Model :

At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working :

Member-facing and approved out-of-state roles remain remote.

Physical Requirements :

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office / deskwork - Activity level : Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity :

External hires must pass a background check / drug screen. Qualified applicants with arrest records and / or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Salary : $136,400 - $204,600