NCQA Credentialing & Member Experience Program Lead

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

Benefits offered by this job

Medical, dental, and vision coverage

Parental leave and adoption support

Tuition reimbursement

Job summary

Blue Cross NC is seeking a National Committee Quality Assurance (NCQA) Program Manager to oversee accreditation activities with emphasis on Credentialing and Member Experience. The role drives readiness, keeps programs compliant, and partners across the organization to support NCQA surveys.

The candidate should bring substantial NCQA accreditation experience and a strong ability to coordinate with Credentialing Operations, Network Management, and delegated entities to ensure timely survey

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

• Serve as the organizational lead for NCQA Credentialing and Recredentialing (CR) standards, ensuring policies, 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.

Skills

NCQA accreditation

Credentialing oversight

Cross-functional collaboration

Analytical skills

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 oversee accreditation activities with emphasis on Credentialing and Member Experience. The role drives readiness, keeps programs compliant, and partners across the organization to support NCQA surveys.

The candidate should bring substantial NCQA accreditation experience and a strong ability to coordinate with Credentialing Operations, Network Management, and delegated entities to ensure timely survey