Accreditation Program Manager

Salary Range: $107,930 - $167,292
The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change.

FLSA Status:Exempt
Department:Quality Improvement
Reports To: Manager, Process Improvement

The Accreditation Program Manager is responsible for developing work plans, gap analyses, conducting internal audits, reviewing documentation for compliance, and facilitating stakeholder collaboration for all program planning and work stream facilitation in support of National Committee for Quality Assurance (NCQA) accreditation survey readiness. The Accreditation Program Manager is responsible for working collaboratively and cross-functionally with internal and external stakeholders, including consultants, auditors and surveyors to create efficiencies and improvements to meet accreditation standards at Santa Clara Family Health Plan (SCFHP). In addition, the Accreditation Program Manager is responsible for projects assigned, including providing ongoing support to organizational initiatives by leading the analysis and implementation of accreditation related medium to large scale projects and efforts.

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.

1. Lead and organize all accreditation activities to achieve and maintain plan accreditation in Medicare and Medi-Cal lines of business including creating, monitoring and executing project work plans and deliverables with business units.

2. Serve as accreditation liaison, working collaboratively and cross-functionally with internal and external stakeholders to ensure NCQA compliance, including delegates.

3. Serve as the primary point of contact with NCQA for policy clarification questions, administrative maintenance, payment of invoices, survey preparation and any other communication.

4. Lead and facilitate medium to large scale quality and process improvement projects by providing direction for project framing, organization, business case analysis, implementation, and outcome/success measurement related to accreditation requirements.

5. Conduct routine internal audits to assess business unit readiness for document review and onsite file review. Work alongside project managers to facilitate workgroups and track standards deliverables progress.

6. Drive adoption of continuous improvement across the organization by supporting and coordinating business change initiatives and activities associated with process improvements and system changes to ensure smooth transitions for stakeholders related to accreditation requirements. Partner with Compliance department to streamline internal and external audit and oversight requirements of accreditation.

7. Define organization standards for consistent approach to accreditation work and coach business partners on application of the standards

8. Develop and maintain all appropriate accreditation project documentation, including timelines, project scope, decision logs, work plans and internal website presence. This includes development of process documents including, policies/procedures, process maps, workflows, desktop procedures, and deliverable templates.

9. Maintain accreditation program documentation for annual committee review schedules and workgroup membership. Where revisions are needed, work directly with business units to adjust.

10. Identify, research, and resolve accreditation project issues and escalate critical issues, problems, and delays to management and executive leadership, as needed.

11. Conduct an annual review of revisions to accreditation standards and ongoing evaluation and interpretation of quality standards and accreditation standards to ensure compliance, including impact to existing delegation agreements.

12. Develop and maintain training materials for new and existing staff to help interpret and understand requirements and the impact of changes.

13. Develop and distribute timely accreditation project communications and status updates.

14. Maintain a thorough knowledge of NCQA requirements to ensure compliance and understand the impact on various areas of operations.

15. Work collaboratively with peers, executives and front line staff to drive improvements in existing operations, and develop/implement initiatives to improve efficiency and effectiveness.

16. Perform other related duties as required or assigned.

The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

1. Bachelor's Degree in Management, Business, Healthcare, or a related field, or equivalent experience. (R)

2. Minimum three years of experience in health and/or managed care with responsibility for accreditation including one year of serving as subject matter expert or main point of contact. (R)

3. Minimum two years of project management experience. (R)

4. Ability to effectively facilitate meetings and deliver information/presentations. (R)

5. Ability to organize, plan, direct and manage medium to large scale, complex, cross-functional, multi-departmental projects. (R)

6. Strong organizational skills; able to adapt to changing environment, work independently, and manage multi-task responsibilities. (R)

7. Ability to work with a high level of independence with strong collaboration and relationship management skills. (R)

8. Strong analytical and problem solving abilities (R)

9. Knowledge of operational areas, quality improvement, IT, and health services in a health plan or integrated delivery system. (D)

10. Project management certification. (D)

11. Working knowledge of process improvement methodologies (R)

12. Lean or Six Sigma certification (D)

13. Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as such as MS Word, Excel, Power Point, Visio, Project and Outlook. (R)

14. Ability to use a keyboard with moderate speed and a high level of accuracy. (R)

15. Excellent communication skills including the ability to express oneself clearly and concisely when interacting with internal and external stakeholders over the telephone, in person or in writing. (R)

16. Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)

17. Ability to assume responsibility and exercise good judgment when making decisions within scope of the position. (R)

18. Ability to maintain confidentiality. (R)

19. Ability to comply with all SCFHP policies and procedures. (R)

20. Ability to perform the job safely and with respect to others, to property and to individual safety. (R)

Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications.

Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:

1. Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R)

2. Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R)

3. Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R)

4. Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R)

5. Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)

6. Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R)

General office conditions. May be exposed to moderate noise levels.

EOE