NCQA Program Lead: Credentialing & Member Experience

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

Benefits offered by this job

Work-life balance

Medical, dental, and vision coverage

Parental leave and adoption support

Tuition reimbursement

401k with company match

Career development programs

Job summary

Blue Cross NC in the United States 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 and cross-functional collaboration to support NCQA survey outcomes.

The ideal candidate brings strong NCQA accreditation and credentialing oversight experience, and will partner across Credentialing Operations, Network Management, and

Qualifications

• Bachelor’s degree or equivalent experience.
• 3+ years of experience in related field; in lieu of degree, 5+ years.
• Experience in healthcare, quality, or compliance is a plus.

Responsibilities

• Lead NCQA Credentialing and Recredentialing standards oversight.
• Manage readiness assessments and mock surveys for Credentialing and Member Experience.
• Oversee credentialing delegates, audits, and corrective actions.
• Collaborate across departments to maintain NCQA compliance and data submissions.
• Prepare for NCQA File Reviews, including action plans and survey responses.
• Plan and oversee NCQA Health Plan Accreditation programs and work plans.
• Develop tracking tools to monitor progress, risks, and compliance.
• Coordinate survey activities and stakeholder engagement.
• Act as SME on NCQA standards for ME and Credentialing/Recredentialing.

Skills

Program management

Budgeting

Organizational skills

Communication

Problem solving

Analytics

Cross-functional collaboration

Process improvement

Education

Bachelor’s degree

Equivalent experience

Tools

Excel

PowerPoint

Teams

SharePoint

Job description

Blue Cross NC in the United States 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 and cross-functional collaboration to support NCQA survey outcomes.

The ideal candidate brings strong NCQA accreditation and credentialing oversight experience, and will partner across Credentialing Operations, Network Management, and