NCQA Credentialing & Compliance Program Manager

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

Benefits offered by this job

Medical, dental, and vision coverage

Parental leave & surrogacy/adoption

Tuition reimbursement

401k with company match

Career development programs

Job summary

Blue Cross NC is seeking a National Committee Quality Assurance (NCQA) Program Manager to lead Health Plan Accreditation activities with emphasis on Member Experience and Credentialing. You will drive organizational readiness, ensure ongoing compliance, and collaborate cross-functionally to support NCQA survey outcomes.

Ideal candidate has NCQA accreditation experience and credentialing oversight in a matrixed healthcare environment, with strong collaboration and data reporting skills.

Qualifications

• Bachelor’s degree or equivalent experience.
• 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 oversight to meet accreditation requirements.
• Lead annual NCQA readiness assessments and mock surveys for Credentialing and Member Experience.
• Support oversight of credentialing delegates and vendors with performance monitoring and audits.
• Partner with Credentialing Operations, Network Management and delegated entities to ensure ongoing compliance with NCQA CR standards.
• Lead preparation for NCQA Credentialing File Reviews and survey response development.
• Lead planning and oversight of NCQA Health Plan Accreditation programs and timelines.
• Develop and maintain the NCQA program work plan and tracking tools.
• Coordinate NCQA survey activities, including document management and submission readiness.
• Serve as SME on NCQA standards, especially Member Experience and Credentialing/Recredentialing.
• Interpret standards and help implement compliant processes.

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

Tools

Microsoft Excel

PowerPoint

Teams

SharePoint

Job description

Blue Cross NC is seeking a National Committee Quality Assurance (NCQA) Program Manager to lead Health Plan Accreditation activities with emphasis on Member Experience and Credentialing. You will drive organizational readiness, ensure ongoing compliance, and collaborate cross-functionally to support NCQA survey outcomes.

Ideal candidate has NCQA accreditation experience and credentialing oversight in a matrixed healthcare environment, with strong collaboration and data reporting skills.