Accreditation Program Manager Job at Blue Cross Blue Shield of Arizona (Phoenix)

Job Description

Under the direction of Medicaid Segment’s Executive Leadership, the Accreditation Program Manager oversees all facets of the accreditation and survey readiness process across multiple lines of business, as applicable, including Medicaid and Medicare Advantage Health Plans.

Job Responsibility

Facilitate the collection, review, preparation and submission of health plan documentation needed for an accreditation survey
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.
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.
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.
Complete readiness monitoring audits and any other assigned tasks within the timeframe provided by management.
Support Health Plan activities to ensure proper implementation and dissemination of accreditation and regulatory requirements.
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.
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

Requirements

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.

Nice to have

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 certification
Needs assessment and data analysis skills sufficient to monitor and evaluate quality improvement activity outcomes

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Accreditation Program Manager

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