NCQA Credentialing & Accreditation Program Lead

Blue Cross and Blue Shield of North Carolina; Virginia (IL); On-site; USD 74,000 - 118,000; Full time

Benefits offered by this job

Work‑life balance and flexibility

Medical, dental, and vision coverage

Parental leave and adoption support

Tuition reimbursement

401k with company match

Job summary

Blue Cross NC is seeking a National Committee Quality Assurance (NCQA) Program Manager to lead Health Plan Accreditation activities with a focus on Member Experience and Credentialing standards.

The role drives organizational readiness, ensures ongoing compliance, and partners cross-functionally to support NCQA survey outcomes. Ideal candidates possess strong NCQA accreditation and credentialing oversight experience and can lead multi‑team initiatives.

Qualifications

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

Responsibilities

• Lead 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.

Skills

Budgeting

Office Administration

Process Improvements

Program Administration

Program Documentation

Program Evaluations

Program Implementation

Program Management

Project Management

Resource Allocation

Education

Bachelor’s degree or equivalent experience

3+ years of experience in related field

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

Job description

Blue Cross NC is seeking a National Committee Quality Assurance (NCQA) Program Manager to lead Health Plan Accreditation activities with a focus on Member Experience and Credentialing standards.

The role drives organizational readiness, ensures ongoing compliance, and partners cross-functionally to support NCQA survey outcomes. Ideal candidates possess strong NCQA accreditation and credentialing oversight experience and can lead multi‑team initiatives.