Accreditation Program Specialist

bcbsa; Washington (District of Columbia); Hybrid; USD 104,000 - 140,000; Full time

Job summary

Blue Cross Blue Shield Association is seeking a senior professional to lead cross-functional projects related to Health Plan accreditation and NCQA/URAC submissions. The role acts as the subject matter expert, developing evidence and tools to ensure compliance and providing tactical guidance to Plans and BCBSA stakeholders.

You will manage complex accreditation projects, build consensus, and deliver strategic recommendations.

Qualifications

• Bachelor's degree in health administration, nursing, public health or related discipline; or equivalent work experience
• 5+ years experience with URAC/NCQA accreditation standards in a managed care setting
• Demonstrated ability to work collaboratively on strategies and translate them into actionable plans and reports
• Strong relationships with Plans, stakeholders and internal/external contacts
• Excellent presentations skills and ability to facilitate meetings and conferences
• Detail-oriented to ensure compliance with accreditation standards
• Advanced analytical skills to interpret data and conduct complex analysis
• Proficiency with Microsoft Office applications (Project, Word, Excel, PowerPoint)

Responsibilities

• Lead multiple complex accreditation projects and serve as a subject matter expert
• Develop tools and evidence to ensure compliance with NCQA/URAC standards
• Create documentation for NCQA Corporate Survey and URAC submissions
• Act as liaison and oversight for accreditation vendors and stakeholders
• Translate trends into strategic action plans addressing program needs
• Prepare content and slides for Accreditation Town Hall presentations
• Provide guidance on standards interpretation for accreditation compliance
• Manage cross-departmental inputs and build consensus across Plans and BCBSA departments

Skills

Collaboration

Presentation skills

Analytical skills

Project management

Stakeholder management

Data analysis

Education

Bachelor's degree in health administration, nursing, public health or related

Tools

Microsoft Project

Word

Excel

PowerPoint

Job description

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.

#LI-Hybrid

The posted salary range is the lowest to highest salary we , in good faith , believe we would pay for this role at the time of this posting . We may ultimately pay more or less than the hiring range and t this hiring range may also be modified in the future. A candidate's position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay.

We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/