Program Manager IV, Health Plan Accreditation
About The Position
The Program Manager IV is an experienced program management professional with demonstrated expertise in NCQA accreditation. This position leads Sutter Health Plan's NCQA accreditation strategy, with primary accountability for maintaining continuous survey readiness and successfully completing the triennial renewal process. The role drives cross-functional coordination across quality, utilization management, credentialing, population health, provider network, and other operational departments to ensure sustained compliance with NCQA standards and policies. Core responsibilities include managing the accreditation project timeline and document submission process, conducting ongoing gap analyses against current NCQA standards, coordinating mock surveys and internal readiness assessments, and serving as the primary liaison with NCQA during survey activities. The Program Manager IV also leads the annual review and update of accreditation-related policies and procedures, delivers training to affected departments on standard revisions, oversees corrective action planning in response to survey findings or standard changes, and monitors regulatory developments—including DMHC requirements—that intersect with NCQA compliance obligations. In addition to the core accreditation program, this position is responsible for Delegation Oversight of quality functions for the plan's dental and vision partners, supporting the Quality Improvement Committee, and leading the plan's annual Member Experience Analysis. This role requires shared accountability for achieving accreditation outcomes, quality performance goals, and program-level service standards. The Program Manager IV demonstrates sound judgment in leveraging existing organizational resources, systems, and subject matter expertise to accomplish program objectives efficiently, and maintains clear accountability boundaries across cross-functional teams—escalating decisions and risks that impact scope through appropriate channels. Maintains detailed program documentation, including project plans, status trackers, meeting minutes, and evidence files, in accordance with departmental standards and NCQA audit requirements; proactively identifies and communicates risks to project timelines. Must be able to assess and interpret quality and program performance data, translating findings into clear reports and written narratives suitable for operational, committee, and executive audiences. Demonstrated proficiency in Microsoft Office Suite (Word, Excel, Visio, PowerPoint, Outlook, Teams) and project management applications (e.g., Microsoft Project or equivalent); ability to develop and maintain complex workplans, track deliverables, and produce polished documentation and executive-level presentations independently.
Requirements
- NCQA accreditation expertise.
- 8 years recent relevant experience.
- Knowledge and understanding of strategic planning, including group facilitation and plan development.
- Knowledge and understanding of business plan development, including qualitative and quantitative research and analysis.
- Well-developed communication and interpersonal skills.
- Ability to interact with a wide variety of internal and external customers, including patients, physicians, payors.
- Demonstrated proficiency in Microsoft Office Suite (Word, Excel, Visio, PowerPoint, Outlook, Teams).
- Demonstrated proficiency in project management applications (e.g., Microsoft Project or equivalent).
Nice To Haves
- Bachelor's degree in Business Administration or related field (equivalent experience will be accepted).
Responsibilities
- Lead Sutter Health Plan's NCQA accreditation strategy.
- Maintain continuous survey readiness and successfully complete the triennial renewal process.
- Drive cross-functional coordination across quality, utilization management, credentialing, population health, provider network, and other operational departments to ensure sustained compliance with NCQA standards and policies.
- Manage the accreditation project timeline and document submission process.
- Conduct ongoing gap analyses against current NCQA standards.
- Coordinate mock surveys and internal readiness assessments.
- Serve as the primary liaison with NCQA during survey activities.
- Lead the annual review and update of accreditation-related policies and procedures.
- Deliver training to affected departments on standard revisions.
- Oversee corrective action planning in response to survey findings or standard changes.
- Monitor regulatory developments—including DMHC requirements—that intersect with NCQA compliance obligations.
- Oversee quality functions for the plan's dental and vision partners.
- Support the Quality Improvement Committee.
- Lead the plan's annual Member Experience Analysis.
- Achieve accreditation outcomes, quality performance goals, and program-level service standards.
- Leverage existing organizational resources, systems, and subject matter expertise to accomplish program objectives efficiently.
- Maintain clear accountability boundaries across cross-functional teams.
- Escalate decisions and risks that impact scope through appropriate channels.
- Maintain detailed program documentation, including project plans, status trackers, meeting minutes, and evidence files.
- Proactively identify and communicate risks to project timelines.
- Assess and interpret quality and program performance data, translating findings into clear reports and written narratives suitable for operational, committee, and executive audiences.
- Develop and maintain complex workplans, track deliverables, and produce polished documentation and executive-level presentations independently.
Benefits
- Comprehensive benefits package
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What This Job Offers
Job Type
Full-time
Career Level
Senior
