Blue Cross Blue Shield of Arizona · 3 days ago
Director, NCQA Accreditation (Hybrid)
Phoenix, AZ
Full-time
Hybrid
Senior Level, Lead/Staff
10+ years expBlue Cross Blue Shield of Arizona is dedicated to inspiring health and providing various health insurance products and services. The Director of NCQA Accreditation will develop and oversee the Medicaid Segment's Accreditation Plan, ensuring compliance with accrediting bodies and managing accreditation preparation activities.
Financial ServicesHealth CareHealth InsuranceInsurance
Responsibilities
Develop and implement an Accreditation Program to include organization wide training and preparation for accreditation surveys, and ongoing readiness activities
Coordinate and oversee regulatory activities to ensure integration and cohesion throughout accredited divisions
Act as resource to staff and other departments in the area of accreditation and quality improvement
Coordinate and submit applications, attestations, and required accreditation documents to the accrediting body and CMS
Coordinate and supervise accreditation reviews and function as the liaison between the organization and the accrediting body
Develop and train staff on the use of processes and tools to assess compliance with accreditation standards
Develop and implement an ongoing accreditation readiness assessment program
Ensure a comprehensive delegation oversight program is in place. Evaluates and modifies oversight program as needed to ensure ongoing business needs and requirements met
Participate on internal, external and Association workgroups and teams as needed
Assist leadership monitoring and analysis of accreditation outcomes to promote meeting goals, objectives, accreditation, and regulatory requirements, and accreditation related quality improvement activities are effective
Prepare and deliver Executive Summary reports
Maintain Business Continuity Plan for the Quality Department annually
Plan, organize and direct staff to optimize the day to day operations of the quality and accreditation department
Serve as the subject matter expert to the internal organization for accreditation and clinical quality
Assume a leadership role in the development of any direct reports and acquisition of new talent by providing challenges and opportunities for awareness and growth
Maintain effective working relationships to ensure teamwork in achieving corporate goals
Foster good communication with staff by setting clear directives, objectives and providing exchange of ideas
Provide leadership and recommend change management principles to ensure they maximize benefit and alleviate unnecessary disruption
Collaborate with Data Science and Analytics to analyze utilization and identify opportunities to offer additional health management services to various customer segments, as well as, trend analysis and development of services for program advancement
Manage use of corporate funds including budgeting, financial management, and reporting. Monitor and report on quarterly budget variances. Identify opportunities to achieve administrative efficiencies while maintaining service
Establish department goals in accordance with overall BCBSAZ objectives and divisional strategic planning
Participate in strategic planning activities and contribute to departmental and cross-functional teams to achieve the Medicaid Segment and BCBSAZ’s future success
Ensure the existence of documented department policies and procedures
Coordinate activities between multiple divisions to achieve desired results
Volunteer within the community to help BCBSAZ give back to community charitable efforts
The position has an onsite expectation of 2 days 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. Onsite expectations can change based on the business need
Perform all other duties as assigned
Qualification
Required
10 years of experience in the application of managed care practices
10 years of quality and management experience
5 years of accreditation experience
5 years of Medicare or Medicaid experience
Bachelor's degree in a Health Service related field
Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a registered nurse (RN)
Strong organizational skills
Strong written and verbal communications
Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
Strong skill in word processing, spreadsheet and database software
Strong PC proficiency
Excellent management skills as they relate to clerical and professional staff
Comprehensive knowledge of Medicaid, Medicare, DSNP, CMS, and AHCCCS program regulations and standard policies and procedures
Comprehensive knowledge of Accreditation processes and compliance
Interpersonal skills that allow for harmonious relationships with providers, members and coworkers
Ability to successfully function in an environment characterized by risk taking, rapidly changing market conditions, strong competition and restructuring
Proven knowledge of medical care delivery systems, quality management, benefit interpretation, provider relationships, and member services
Strong understanding of the costs/quality challenges of today's health care environment
Strong understanding of quality metrics and measurement methods
Ability to identify key strategic performance measures for success
The capacity, maturity, stature, and communication skills to assume a leadership role in a progressive, growing, and changing organization
Ability to work with business unit managers in a partnership setting
Ability to work with executive leadership in a professional and collaborative role
Preferred
10 years' experience in Quality Management, continuous quality improvement and outcomes reporting
3 years of experience in developing short and long range strategic plans, forecasting, and budgeting
5 years of experience in providing leadership to an established, sophisticated medical/health management division of a health insurance organization
Post-graduate education in Health Care Administration, Public Health and/or M.B.A
Certified Specialist in Healthcare Accreditation (CSHA)
Certified Professional in Healthcare Quality (CPHQ)
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
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