Accreditation Program Specialist

Blue Cross and Blue Shield Association•Chicago, WA

17h•Hybrid

About The Position

This role is responsible for leading multiple cross-functional projects, services and associated deliverables related to Federal Employee Program (FEP) and local Blue Plans Heath Plan Accreditation, the Accreditation Town Hall call, as well as other initiatives. Functions as a subject matter expert for Health Plan accreditation and delegation oversight. Manage relationships with Plan accreditation contacts and accreditors, develop strategic recommendations, and provide tactical guidance to Plans and FEP regarding Health Plan and National Committee for Quality Assurance (NCQA) Corporate Survey accreditation. Leads and manages multiple complex projects for Health Plan Accreditation, serving as a subject matter expert. Creates tools, supports evidence, and conducts reviews to ensure compliance with accreditation standards, while providing ongoing guidance to Plans. Builds strategies for compliance, fosters collaborative relationships, and resolves complex issues using available resources and expertise. Develops accreditor-compliant documentation for submission in the NCQA Corporate Survey and for Plan Utilization Review Accreditation Commission (URAC) accreditation submissions. Acts as the primary resource and administrator for NCQA’s Interactive Survey Tool, and URAC’s web-based application (e.g., AccreditNet) used for evidence of accreditation compliance. Serves as liaison and conducts delegation oversight of vendors. Develops work plans meet specific identified current leadership and Plan needs. Prioritizes Health Plan accreditation activities by identifying critical issues to develop and implement strategies to address issues by building consensus with Plans and/or internal BCBSA departments. Manage variances within internal BCBSA departments and/or Plans resulting in a successful accreditation survey. Develops content and slides about relevant accreditation topics, and presents to Plans via the Accreditation Town Hall call. Serves as a resource for Health Plan accreditation questions internally and externally through the Accreditation mailbox. Translates trend information into strategic action plans to address program and customer business needs. Leads or participates in teams to implement recommendations and conducts mock surveys for Health Plan accreditation reviews as needed. Acts as a contact and resource for Plans, internal BCBSA staff, and external parties, providing guidance on standards interpretation related to Health Plan Accreditation.

Requirements

Bachelor's Degree in Health administration, nursing, public health or related discipline; or equivalent work experience
5+ Years experience with URAC/NCQA accreditation standards and in a managed care setting
Demonstrated ability to work collaboratively on strategies that support accreditation and implementation of those strategies into effective into action plans, documents and reports
Develops strong working relationships with key constituents include Plans, internal and external stakeholders and contacts
Demonstrated ability to handle multiple projects, prioritizing critical aspects/tasks, working under pressure and meeting multiple deadlines
Excellent presentations skills including the ability to plan, facilitate and present at meetings and conferences
Detail-oriented to ensure compliance with accreditation standards
Advanced analytical skills with the ability to analyze and interpret data, research results and conduct complex analysis
Utilizes effective conflict management skills to manage competing interests and navigate difficult solutions including the ability to negotiate outcomes to ensure accreditor compliance
Proficiency with the use of a variety of software applications (e.g., Microsoft Project, Word, Excel, and PowerPoint)

Nice To Haves

RN - Registered Nurse - State Licensure and/or Compact State Licensure - Various
Active, unrestricted Registered Nurse (RN) License.
Experience managing projects that require cross-departmental inputs and functionality.

Responsibilities

Lead multiple cross-functional projects, services and associated deliverables related to Federal Employee Program (FEP) and local Blue Plans Heath Plan Accreditation, the Accreditation Town Hall call, as well as other initiatives.
Function as a subject matter expert for Health Plan accreditation and delegation oversight.
Manage relationships with Plan accreditation contacts and accreditors.
Develop strategic recommendations and provide tactical guidance to Plans and FEP regarding Health Plan and National Committee for Quality Assurance (NCQA) Corporate Survey accreditation.
Lead and manage multiple complex projects for Health Plan Accreditation, serving as a subject matter expert.
Create tools, support evidence, and conduct reviews to ensure compliance with accreditation standards, while providing ongoing guidance to Plans.
Build strategies for compliance, foster collaborative relationships, and resolve complex issues using available resources and expertise.
Develop accreditor-compliant documentation for submission in the NCQA Corporate Survey and for Plan Utilization Review Accreditation Commission (URAC) accreditation submissions.
Act as the primary resource and administrator for NCQA’s Interactive Survey Tool, and URAC’s web-based application (e.g., AccreditNet) used for evidence of accreditation compliance.
Serve as liaison and conduct delegation oversight of vendors.
Develop work plans to meet specific identified current leadership and Plan needs.
Prioritize Health Plan accreditation activities by identifying critical issues to develop and implement strategies to address issues by building consensus with Plans and/or internal BCBSA departments.
Manage variances within internal BCBSA departments and/or Plans resulting in a successful accreditation survey.
Develop content and slides about relevant accreditation topics, and present to Plans via the Accreditation Town Hall call.
Serve as a resource for Health Plan accreditation questions internally and externally through the Accreditation mailbox.
Translate trend information into strategic action plans to address program and customer business needs.
Lead or participate in teams to implement recommendations and conduct mock surveys for Health Plan accreditation reviews as needed.
Act as a contact and resource for Plans, internal BCBSA staff, and external parties, providing guidance on standards interpretation related to Health Plan Accreditation.