Blue Cross Blue Shield of Arizona · 10 hours ago
Accreditation Program Manager - Hybrid
Phoenix, AZ
Full-time
Hybrid
Senior Level
5+ years expBlue Cross Blue Shield of Arizona is dedicated to inspiring health and providing diverse health insurance products and services. The Accreditation Program Manager oversees the accreditation and survey readiness process across multiple lines of business, ensuring compliance with accreditation standards and facilitating communication with accreditation organizations.
Financial ServicesHealth CareHealth InsuranceInsurance
Responsibilities
Facilitate the collection, review, preparation and submission of health plan documentation needed for an accreditation survey including but not limited to:
Serves as the Liaison and primarily point of contact with NCQA (and other accreditation organizations where applicable)
Ensures all deliverables related to accreditation are timely and accurate including but not limited to the review and approval of organizational policies and procedures. Contributions include offering recommendations for edits and citations addressing accreditation standards/elements/factors within the document
Distributes and discusses NCQA Standards and updates to responsible parties; and conducts frequent project assessments, Identifying, reporting, and addressing any gaps in policy or procedure, as related to accreditation
Create, develop, and maintain the accreditor's survey work tool in order to ensure timely submission of the survey documentation
Perform annual gap analyses across multiple lines of business to ensure health plans can operationalize the annual updates to NCQA accreditation standards. The gap analyses will include but are not limited to: Conduct an annual review and comparison of the current year's accreditation standards against the next year's standards revisions to determine areas of risks to maintaining accreditation and reporting any findings to management for follow-up
Responsible for the development and maintenance of an ongoing project plan for managing and reporting accreditation activities across all product lines
Conduct survey readiness auditing and monitoring activities to support organizational accreditation (i.e. NCQA) and regulatory monitoring requirements (i.e. CMS Model of Care, state mandated EQRO reviews, state Operational Reviews)
Create, develop, and maintain internal audit tools to be used to conduct survey readiness assessments and monitoring
Perform survey readiness monitoring using internal audit tools with the goal being that the most stringent standard, either accreditation or regulatory, is being followed by the health plan. Develop survey audit tools for on-going monitoring and auditing of internal and external departmental activities to ensure the organization is meeting all NCQA requirements throughout the year
Complete readiness monitoring audits and any other assigned tasks within the timeframe provided by management. Immediately report any deficiencies or risks identified during readiness monitoring immediately to management
Support Health Plan activities to ensure proper implementation and dissemination of accreditation and regulatory requirements. Also serve as a resource to other departments for compliance with accreditation standards
Create and development power-point presentations targeting Quality and Accreditation to be used by the Human Resources department for employee education activities (i.e. Learning Management Systems)
Serve as the point-person and resource for accreditation activities including but not limited to NCQA communications, internal education and/or outreach activities, questions related to NCQA standards. Responsibilities also include creation and presentation of training materials for staff regarding NCQA requirements
Responsible for the collection, coordination, preparation and submission of survey documents; ensuring timeliness and accuracy for all submissions
Provide frequent updates on accreditation efforts and status to Executive Leadership, including presentation of reports for revieing and assessing status of accreditation efforts
Position requires contact with both internal and external entities including vendors, contractors, state and federal officials, Health Plan members, and providers
Able to travel to off-site meetings and conferences as required
Perform all other duties as assigned
The position has an onsite expectation of 1 day per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements
Qualification
Required
Minimum of 5 years of experience with NCQA (Specific) Accreditation
Minimum of 1 year of experience in a Leadership role with a Managed Care Organization
High-School Diploma or GED in general field of study
Valid Arizona Driver License, with an acceptable driving record
Personal computer proficiency with Microsoft Office - Word, Excel, Outlook, and PowerPoint
Data analysis and critical thinking skills, problem solving, organizational, detail orientation, and strong writing skills
Strong time management skills
Knowledge of performance standards as applicable to the health plan accreditation process
Ability to work in a team environment
Strong interpersonal and communication skills
Maintains confidentiality and projects a professional business image
Must be able to effectively communicate with internal and external customers via telephone and email
Able to maintain a calm and collected presence while addressing the concerns from an internal and external customer
Able to accurately receive information through oral communication
Able to focus on a specific event or activity for up to four (4) hours at a time without interruption
Able to accurately learn and retain new information, knowledge, and skills
Able to efficiently manage multiple tasks, with varying degrees of priority, at the same time
Able to accurately sort through data and think through issues in a time-pressured environment
Preferred
10 years of experience in a Leadership role with a HMO/Managed Care Organization (preferably specific to Arizona Medicaid – AHCCCS; and/or a Medicare Advantage Plan)
5 years of experience specifically with NCQA Accreditation; with oversight, monitoring, and engagement in survey readiness and auditing
Bachelor's Degree in business, healthcare administration, or related field of study
Registered Nurse (RN)
Project Management
Needs assessment and data analysis skills sufficient to monitor and evaluate quality improvement activity outcomes
Company
Blue Cross Blue Shield of Arizona
Blue Cross Blue Shield of Arizona is a non-profit company that offers health insurance and financial services.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Pam Kehaly
President and Chief Executive Officer
Recent News
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