Accreditation Program Manager - Hybrid

Overview

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, onsite at least twice per week
• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, onsite at least once per week
• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, onsite at least once per month
• Onsite: daily onsite requirement based on the essential functions of the job
• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This position is hybrid within the state of AZ only. This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.

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.

Required Qualifications

• 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

Required Education

• High-School Diploma or GED in general field of study

Required Licenses

• Valid Arizona Driver License, with an acceptable driving record

Required Certifications

• N/A

Preferred Qualifications

Preferred Work Experience

• 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.

Preferred Education

• Bachelor's Degree in business, healthcare administration, or related field of study

Preferred Licenses

• Registered Nurse (RN)

Preferred Certifications

• Project Management

• Facilitate the collection, review, preparation and submission of health plan documentation needed for an accreditation survey including but not limited to:

• 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. Contributions include offering recommendations for edits and citations addressing accreditation standards/elements/factors within the document
• 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. The gap analyses will include but are not limited to:
  Conduct an annual review and comparison of the current year s accreditation standards against the next year s standards revisions to determine areas of risks to maintaining accreditation and reporting any findings to management for follow-up
• 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…