NCQA Program Manager

Key Responsibilities‍

Accreditation Planning and Execution

Develop and manage the comprehensive accreditation plan, including required deliverables (e.g., P&Ps, program documents, timelines, milestones, and necessary data collection activities) to meet NCQA requirements.

Standard Interpretation

Act as a subject matter expert on NCQA Health Plan Accreditation standards, ensuring accurate interpretation and implementation within the organization.

Collaborate with NCQA directly, as applicable, to facilitate policy clarification and guidance.

Data Collection and Analysis

Oversee the collection, analysis, and reporting of quality data required for NCQA accreditation, engaging leaders and subject matter experts in qualitative analysis and guiding areas for improvement and development of corrective action plans.

Quality Improvement Initiatives

Internal Stakeholder Collaboration

Coordinate with departments, including clinical teams, operations, and quality management, to ensure alignment with accreditation requirements.

Reporting and Communication

Prepare regular and at least quarterly reports on accreditation compliance status, key performance indicators, and quality improvement progress to leadership and relevant stakeholders.

Compliance Monitoring

Conduct ongoing monitoring to identify potential compliance issues related to NCQA standards and implement corrective actions where necessary.

Survey Audit Preparation

Lead the preparation for NCQA audits, including data compilation, documentation review, conference calls, virtual on-site preparations, and staff training to ensure a successful accreditation outcome. 

Required Skills and Qualifications:

Healthcare Expertise

Strong understanding of managed healthcare operations, quality improvement methodologies, and clinical practice guidelines.

NCQA Accreditation Standards and Survey Process Knowledge

Comprehensive knowledge of NCQA Health Plan Accreditation standards, policies and procedures, data reporting requirements, and audit processes.

Analytical Skills

Proficiency in data analysis, interpretation, and reporting to identify trends and areas for improvement.

Critical Thinking and Problem-Solving Skills

Strategic thinker who can assess problems and act decisively and collaboratively to find innovative solutions.

Project Management Skills

Ability to manage complex projects that require collaboration across the organization and have multiple timelines and deliverables. Ability to maintain focus on achieving accreditation goals.

Communication Skills

Excellent written and verbal communication skills to effectively convey complex information to various stakeholders.

Leadership Abilities

Ability to lead cross-functional teams, collaborate across the organization, and influence stakeholders to achieve a common goal (often related to quality improvement objectives). 

Startup Spirit

Ability to combine an understanding of company vision, mission, and strategy with passion, grit, and perseverance necessary to achieve long-term goals. 

Education and Experience

• Minimum of five years experience working in a health plan
• Experience leading NCQA Health Plan Accreditation First and/or Renewal Survey (First Survey experience preferred)
• Certified Professional in Healthcare Quality (CPHQ) or equivalent certification preferred
• Bachelor's degree in healthcare administration, nursing, or related field preferred