NCQA Credentialing & Member Experience Program Manager

Blue Cross and Blue Shield of North Carolina; Town of Texas (WI); 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

401k with company match

Job summary

Blue Cross NC is seeking a National Committee Quality Assurance (NCQA) Program Manager to lead credentialing oversight and ready the organization for NCQA surveys. You will drive compliance, coordinate with Credentialing Operations, Network Management, and delegated entities, and manage file reviews and response development.

The role requires NCQA accreditation experience, a bachelor’s degree (or equivalent) and 3+ years in related work, with potential for cross-functional leadership and program

Qualifications

• Bachelor’s degree or equivalent experience or 5+ years of related field if no degree.
• 3+ years of experience in related field.
• In lieu of degree, 5+ years of experience in related field.

Responsibilities

• Serve as organizational lead for NCQA Credentialing and Recredentialing standards to meet accreditation requirements.
• Lead annual NCQA readiness assessments and mock surveys for Credentialing, Member Experience, and other standards.
• Oversee credentialing delegates and vendors, including audits and corrective action reporting.

Skills

Stakeholder management

Analytical thinking

Strategic planning

Cross-functional collaboration

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 credentialing oversight and ready the organization for NCQA surveys. You will drive compliance, coordinate with Credentialing Operations, Network Management, and delegated entities, and manage file reviews and response development.

The role requires NCQA accreditation experience, a bachelor’s degree (or equivalent) and 3+ years in related work, with potential for cross-functional leadership and program