Program Manager, NCQA

SF Health Plan • San Francisco, CA

2d • Hybrid

About The Position

Reporting to the Director, Regulatory Affairs, the NCQA Program Manager is an experienced healthcare professional who manages and leads activities associated with SFHP's NCQA Accreditation. These activities include ongoing monitoring and analysis of plan performance against the NCQA standards. Additionally, the Program Manager coordinates all NCQA-related activities across the organization to maintain and prepare for ongoing NCQA accreditation and future categories of NCQA accreditation. Position activities involve frequent daily interface with SFHP internal departments to support NCQA accreditation standards. Serve as the departmental contact for all matters related to NCQA accreditation. You must be extremely professional and organized. You must demonstrate high standards of integrity. Additionally, they should enjoy interacting with people at all levels. They thrive in a fast-paced environment. You must be able to motivate others to excel and persist as a team. Furthermore, they should work with minimal supervision. You should be highly organize, possess excellent oral and written communication skills, and focus on details and accuracy. Must be able to multi-task, be flexible and be adaptable. Please note that while SFHP supports a hybrid work environment, you are required to be onsite and in-office a minimum of 4 days per month. This is a hybrid position, based in our Downtown San Francisco office.

Requirements

• Bachelor's degree or equivalent work experience
• 3-5 years of health care-related experience
• Project management experience
• Successful NCQA accreditation process completion and process improvement experience in an NCQA setting.
• Experience analyzing and providing guidance on studies that go along with NCQA.
• Possess a strong quality improvement background that includes managed care and NCQA, specifically within the Medicaid and government-sponsored programs environments.

Responsibilities

• Responsible for professional inquiries, submissions and responses to NCQA.
• Lead and coordinate the NCQA-impacted department communications and activities.
• Transitions our framework from obtaining NCQA accreditation as a project to an ongoing operational effort to maintain NCQA accreditation through the renewal process.
• Manage the accreditation processes and resources required to renew SFHP's accreditation status, including working with staff to ensure the submission of HEDIS and CAHPS data for the renewal survey.
• Evaluate, interpret, and summarize accreditation guidelines on at least an annual basis.
• Manage the process for accreditation activities, including communicating year-to-year changes in standards.
• Assisting departments with updating policies, procedures, workflows, reports, etc., to comply with updated standards.
• Identify appropriate resources and accountabilities within departments involved with accreditation and ensure engagement by all impacted departments.
• Lead coordination and communication with NCQA consultant.
• Conduct the ongoing evaluation and interpretation of accreditation standards to ensure compliance through department lead, reporting and measurement studies/ methodologies.
• Be an expert resource to internal staff across the organization.
• Facilitate project management and develop comprehensive accreditation work plans by establishing deliverables, accountabilities, and timelines.
• Work in collaboration with the Compliance team to monitor activities for compliance with NCQA standards with compliance activities related to compliance with state regulatory and contractual requirements.
• Timely inform and train staff on changes in NCQA accreditation standards and tools.
• Refet substantive questions, important business issues to subject matter experts and follows up to ensure resolution and escalates.
• Assess problems and develop solutions following general policies and procedures and escalate to manager as appropriate.
• Assist manager with budget related to NCQA expenses, including processing invoices and variance reports.
• Lead efforts to manage projects for implementing DHCS, CMS, and DMHC All-Plan Policy letters on an as-needed basis.
• Perform other duties and tasks assigned.

Benefits

• Health Benefits Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.
• Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
• Vision: Employee vision care coverage is available through Vision Service Plan (VSP).
• Retirement: Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.
• Time off: 23 days of Paid Time Off (PTO) and 13 paid holidays.
• Professional development: Opportunities for tuition reimbursement, professional license/membership.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 101-250 employees