Program Manager, NCQA

Reporting to the Director, Regulatory Affairs, the NCQA Program Manager is an experienced healthcare professional who will manage and lead activities associated with SFHP's NCQA Accreditation.

About the role

The goal of these efforts is 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. Be the departmental contact for all matters related to NCQA accreditation. This is a hybrid position based in our Downtown San Francisco office, requiring onsite presence a minimum of 4 days per month.

Responsibilities

• Responsible for project timelines and professional inquiries, submissions, and responses to NCQA.
• Lead the NCQA-impacted department communications and activities.
• Transition the 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 at least annually. Manage the process for accreditation activities, including communicating year-to-year changes in the standards.
• Assist departments with updating policies, procedures, workflows, and reports 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 consultants.
• Conduct ongoing evaluation and interpretation of accreditation standards to ensure compliance through department leads, 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 together with compliance activities related to state regulatory and contractual requirements.
• Inform and train staff on changes in NCQA accreditation standards and tools.
• Refer substantive questions and important business issues to subject matter experts, follow up to ensure resolution, and escalate as needed.
• Assess problems and develop solutions following general procedures, escalating to manager when necessary.
• 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.

Requirements

• Bachelor's degree or equivalent work experience.
• 3 or more years of experience in project management.
• Successful NCQA accreditation process completion and continuous process improvement experience in an NCQA setting.
• Experience analyzing and providing guidance on studies related to NCQA.
• Strong quality improvement background that includes managed care and NCQA, specifically within the Medicaid and government-sponsored programs environments.

Benefits

• Health Benefits
  • Medical: Choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.
  • Dental: Choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
  • Vision: Employee vision care coverage 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.

Pay

$90,000 - $105,000 per year

About SFHP

Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees, and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services.