NCQA Credentialing & Accreditation Lead

Blue Cross and Blue Shield of North Carolina; Kentucky; On-site; USD 74,000 - 118,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Wellness programs

Parental leave and adoption/surrogacy

Tuition reimbursement

401(k) match

Job summary

Blue Cross and Blue Shield of North Carolina is seeking a National Committee Quality Assurance (NCQA) Project/Program Manager to lead Health Plan Accreditation activities with a focus on Member Experience and Credentialing standards. You will drive organizational readiness, ensure ongoing compliance, and partner cross-functionally to support NCQA survey outcomes.

The ideal candidate will have NCQA accreditation experience, credentialing oversight expertise, and the ability to lead

Qualifications

• Bachelor's degree or equivalent experience required.
• 3+ years of experience in related field required.
• In lieu of degree, 5+ years of experience in related field accepted.

Responsibilities

• Lead NCQA Credentialing and Recredentialing standards oversight.
• Manage NCQA readiness assessments and mock surveys for Credentialing and Member Experience.
• Oversight of credentialing delegates and vendors; performance monitoring and audits.
• Coordinate cross-functional activities to ensure NCQA compliance and audit readiness.
• Prepare for NCQA Credentialing File Reviews and survey response development.
• Oversee NCQA Health Plan Accreditation programs with aligned timelines and goals.
• Develop and maintain NCQA program work plans and tracking tools.
• Coordinate NCQA survey activities and stakeholder engagement.
• Serve as SME on NCQA standards with emphasis on Member Experience and Credentialing/Recredentialing.
• Identify gaps, develop mitigation strategies, and report status to leadership.
• Conduct ongoing readiness reviews, audits, and monitoring for sustained compliance.
• Collaborate to develop NCQA data source submission reports (e.g., ME 7).
• Oversee delegated vendor functions to ensure NCQA adherence.

Skills

Project management

Communication skills

Analytical skills

Office software

Education

Bachelor's degree or equivalent experience

5+ years of experience in related field in lieu of degree

Tools

Microsoft Office (Excel, PowerPoint, Teams, SharePoint)

Job description

Blue Cross and Blue Shield of North Carolina is seeking a National Committee Quality Assurance (NCQA) Project/Program Manager to lead Health Plan Accreditation activities with a focus on Member Experience and Credentialing standards. You will drive organizational readiness, ensure ongoing compliance, and partner cross-functionally to support NCQA survey outcomes.

The ideal candidate will have NCQA accreditation experience, credentialing oversight expertise, and the ability to lead