Project​/Program Manager

Job Description

We’re hiring a National Committee Quality Assurance (NCQA) Program Manager to lead our Health Plan Accreditation activities with a primary focus on Member Experience and Credentialing standards. This role drives organizational readiness, ensures ongoing compliance, and partners cross-functionally to support successful NCQA survey outcomes. The ideal candidate brings strong experience in NCQA accreditation and credentialing oversight.

• Serve as the organizational lead for NCQA Credentialing and Recredentialing (CR) standards, ensuring policies, procedures, files, and oversight activities meet accreditation requirements.
• Lead annual NCQA readiness assessments and mock surveys for Credentialing, Member Experience, and other accreditation standards to ensure continuous survey readiness.
• Support oversight of credentialing delegates and vendors, including performance monitoring, annual audits, corrective action plans, and reporting to credentialing governance committees.
• Partner with Credentialing Operations, Network Management, other business areas and delegated entities to ensure ongoing compliance with NCQA CR standards and credentialing-related regulatory requirements.
• Lead preparation for and participation in NCQA Credentialing File Reviews, including file selection, audit readiness assessments, corrective actions, and survey response development.
• Lead planning, execution, and oversight of NCQA Health Plan Accreditation programs, ensuring alignment with organizational goals and timelines.
• Develop and maintain the NCQA program work plan and tracking tools to monitor progress, risks, and compliance status.
• Coordinate NCQA survey activities, including documentation management, submission readiness, and stakeholder engagement.
• Serve as subject matter expert (SME) on NCQA standards, with emphasis on Member Experience and Credentialing/Recredentialing (CR).
• Interpret standards and partner with business owners to operationalize requirements and implement compliant processes.
• Identify gaps and risks; develop mitigation strategies and provide regular status reporting to leadership.
• Conduct ongoing readiness reviews, audits, and monitoring activities to ensure sustained compliance.
• Collaborate with business areas and cross‑functional stakeholders to develop and finalize NCQA data source submission reports (e.g., Member Experience [ME 7]), ensuring accuracy, completeness, and alignment with NCQA standards and audit expectations.
• Oversee delegated vendor functions to ensure adherence to NCQA accreditation requirements.
• Facilitate cross‑functional work groups, committee discussions, and Quality Improvement meetings to drive accountability and readiness.
• Establish and track performance metrics (process, outcome, and compliance measures) and present findings to stakeholders.
• Drive continuous improvement initiatives to enhance quality, efficiency, and accreditation outcomes.
• Analyze policies, workflows, and documentation to improve effectiveness and ensure regulatory alignment.
• Support additional accreditation and compliance initiatives as needed.

• Bachelor’s degree or equivalent experience
• 3+ years of experience in related field
• In lieu of degree, 5+ years of experience in related field

• 5+ years of program or project management experience in healthcare, quality, or compliance
• Demonstrated experience preparing for and supporting NCQA surveys, file reviews, and accreditation submissions.
• Strong working knowledge of health plan credentialing operations, delegated credentialing oversight, and provider network compliance requirements.
• Experience leading cross‑functional accreditation work groups and driving corrective action plans through completion.
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