Director, NCQA Accreditation; 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.

AZ Blue has a hybrid workforce strategy, Workability, that offers flexibility with how and where employees work. Positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following onsite requirements apply:

• Hybrid People Leaders: reside in AZ; onsite at least twice per week

• Hybrid Individual Contributors: reside in AZ (unless otherwise noted in this posting); onsite at least once per week

• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence): reside in AZ (unless otherwise noted); onsite at least once per month

• Onsite: daily onsite requirement based on essential functions

• Remote: not onsite-restricted; leadership may request onsite presence for business reasons

Please note onsite requirements may change based on business need and job responsibilities. Most employees should expect onsite requirements of at least once per week. This role requires work and residency within the state of Arizona.

• Develops, implements and oversees the Medicaid Segment of AZBLUE's Accreditation Plan, leading to successful Accreditation attainment. Directs accreditation preparation activities and accrediting body reviews.
• Maintains and ensures all policies and procedures are up to date and compliant with accrediting and regulatory bodies for the Medicaid Segment, including NCQA, URAC, CMS and AHCCCS.
• Collaborates with the broader AZ Blue accreditation and quality teams to support reaccreditation and jointly operated health plans.
• Works in a matrixed relationship with compliance and legal to ensure regulatory, compliance and legal requirements are met by the Medicaid Segment.
• Facilitates and drives completion of work requirements of all departments accountable for accreditation deliverables for the Medicaid Segment under the authority of the Medicaid Segment 9s Chief Medical Officer and leadership team.

REQUIRED QUALIFICATIONS

2. Required Education

• Bachelor's degree in a Health Service related field

3. Required Licenses

• Active, current, and unrestricted license to practice in the State of Arizona as a registered nurse (RN).

4. Required Certifications

• N/A

PREFERRED QUALIFICATIONS

2. Preferred Education

• Post-graduate education in Health Care Administration, Public Health and/or M.B.A.

3. Preferred Licenses

• N/A

4. Preferred Certifications

• Certified Specialist in Healthcare Accreditation (CSHA)
• Certified Professional in Healthcare Quality (CPHQ)

ACCREDITATION

• Develop and implement an Accreditation Program to include organization wide training and preparation for accreditation surveys, and ongoing readiness activities
• Coordinate and oversee regulatory activities to ensure integration and cohesion throughout accredited divisions
• Act as resource to staff and other departments in accreditation and quality improvement
• Coordinate and submit applications, attestations, and required accreditation documents to the accrediting body and CMS
• Coordinate and supervise accreditation reviews and function as the liaison between the organization and the accrediting body
• Develop and train staff on the use of processes and tools to assess compliance with accreditation standards
• Develop and implement an ongoing…