NCQA Credentialing & Member Experience Program Lead

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

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. This role drives organizational readiness, ensures ongoing compliance, and partners cross‑functionally to support NCQA survey outcomes.

The ideal candidate brings strong NCQA accreditation and credentialing oversight experience, with the ability to collaborate with Credentialing Operations, Network

Qualifications

• NCQA credentialing and related standards knowledge.
• Credentialing oversight experience and regulatory familiarity.
• Strong project management and cross‑functional collaboration skills.

Responsibilities

• Lead NCQA Credentialing and Recredentialing (CR) standards compliance and documentation.
• Run annual NCQA readiness assessments and mock surveys for Credentialing and Member Experience.
• Oversee credentialing delegates, audits, and corrective action reporting.
• Partner with Credentialing Operations, Network Management, and delegated entities to ensure NCQA compliance.
• Prepare for NCQA Credentialing File Reviews and survey responses.

Skills

NCQA credentialing

Credentialing oversight

Project management

Quality/compliance

Stakeholder communication

Education

Bachelor’s degree or equivalent experience

3+ years in related field

In lieu of degree, 5+ years experience

Tools

Microsoft Excel

PowerPoint

Microsoft Teams

SharePoint

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. This role drives organizational readiness, ensures ongoing compliance, and partners cross‑functionally to support NCQA survey outcomes.

The ideal candidate brings strong NCQA accreditation and credentialing oversight experience, with the ability to collaborate with Credentialing Operations, Network