What are the responsibilities and job description for the Health Plan Accreditation Program Manager position at PacificSource Health Plans?
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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.
The Health Plan Accreditation Program Manager provides strategic direction and oversight for all aspects of the National Committee for Quality Assurance (NCQA) accreditation process. This includes planning, organizing, and directing all health plan accreditation activities across the organization, ensuring compliance with NCQA standards, and collaborating with cross-functional teams to achieve organizational goals.
Essential Responsibilities:
- Develop and execute a comprehensive strategy for obtaining or maintaining health plan accreditation for the organization.
- Oversee all aspects of the NCQA project lifecycle, including development of comprehensive accreditation work plans by establishing deliverables, accountabilities, timelines and resource management. Conduct routine monitoring and ensure transparency with stakeholders.
- Act as the primary point of contact for NCQA, facilitating communication and ensuring the health plan stays informed about changes in standards or requirements.
- Lead the organization’s efforts in preparing for NCQA surveys, site visits, and audits. Oversee the preparation, submission, and tracking of documentation required for NCQA accreditation, ensuring compliance with all necessary guidelines.
- Provide strategic direction of accreditation activities, including prioritization of operational, reporting and workflow revisions or development of new to comply with updated and/or new standards.
- Prepare and present reports to executive and senior management regarding quality improvement activities, accreditation status, performance metrics, and areas requiring attention.
- Create and maintain documentation templates and systems to support Quality Management (QM) projects and initiatives.
- Provide training and support to staff on NCQA standards and quality improvement processes.
- Collaborate with business owners to provide leadership and oversight of delegated vendors, establishing the necessary infrastructure and operational mechanisms to ensure continuous compliance with accreditation standards.
- Work closely with the quality improvement teams to drive initiatives aimed at meeting NCQA quality standards. Help prioritize areas that need improvement based on NCQA metrics including but not limited to Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures.
- Monitor clinical performance and outcomes; address areas where performance falls short of NCQA standards.
- Lead continuous quality improvement projects that align with accreditation requirements and organizational goals.
- Evaluate, interpret, and communicate accreditation star ratings.
Supporting Responsibilities:
- Meet department and company performance and attendance expectations.
- Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
- Perform other duties as assigned.
SUCCESS PROFILE
Work Experience: Minimum of five (5) years of healthcare accreditation, quality management, or related healthcare program management experience required. Experience working with NCQA standards is highly preferred. Proven experience leading cross-functional teams.
Education, Certificates, Licenses: Bachelor’s degree in healthcare administration, public health, or a related field, or equivalent years of additional relevant experience in lieu of degree required. Master’s degree preferred. Certified Project Manager (PMP) or ability to obtain certification within 1 year.
Knowledge: In-depth knowledge of accreditation standards, HEDIS and CAHPS measures, and quality improvement methodologies. Ability to manage multiple projects, prioritize tasks, and meet deadlines while overseeing complex accreditation processes. Strong leadership skills to guide cross-functional teams, excellent written and verbal communication skills. Ability to analyze data, identify areas of improvement, and develop actionable plans to address challenges related to accreditation or quality improvement. Adept in working with and presenting to executive level management and external stakeholders. Understanding of healthcare laws, regulations, and standards, especially those related to managed care, quality improvement, and compliance
Competencies
Adaptability
Building Customer Loyalty
Building Strategic Work Relationships
Building Trust
Continuous Improvement
Contributing to Team Success
Planning and Organizing
Work Standards
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time.
Skills:
Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
- We are committed to doing the right thing.
- We are one team working toward a common goal.
- We are each responsible for customer service.
- We practice open communication at all levels of the company to foster individual, team and company growth.
- We actively participate in efforts to improve our many communities-internally and externally.
- We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
- We encourage creativity, innovation, and the pursuit of excellence.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
