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
