Accreditation Program Specialist

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.

The posting range for this position is:

103,676.95 - 140,207.33

Qualifications:

Education

• Required Bachelor's Degree Health administration, nursing, public health or related discipline; or equivalent work experience

Experience

• Required 5+ Years experience with URAC/NCQA accreditation standards and in a managed care setting

Knowledge Skills and Abilities

• 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)

Certifications & Licenses

• Preferred: RN - Registered Nurse - State Licensure and/or Compact State Licensure - Various Active, unrestricted Registered Nurse (RN) License.
• Extra Posting Information:

  Experience with URAC/NCQA accreditation standards and in a managed care setting. Experience managing projects that require cross-departmental inputs and functionality.

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