Project/Program Manager

Remote Flex - North Carolina

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Full time

RQ0018931

Job Description

We’re hiring a National Committee Quality Assurance (NCQA) Program Manager to lead our Health Plan Accreditation activities with a primary focus on Member Experience and Credentialing standards. This role drives organizational readiness, ensures ongoing compliance, and partners cross-functionally to support successful NCQA survey outcomes. The ideal candidate brings strong experience in NCQA accreditation and credentialing oversight.

What You’ll Do

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

• Lead planning, execution, and oversight of NCQA Health Plan Accreditation programs, ensuring alignment with organizational goals and timelines

• Develop and maintain the NCQA program work plan and tracking tools to monitor progress, risks, and compliance status

• Coordinate NCQA survey activities, including documentation management, submission readiness, and stakeholder engagement

• Serve as subject matter expert (SME) on NCQA standards, with emphasis on Member Experience and Credentialing/Recredentialing (CR)

• Interpret standards and partner with business owners to operationalize requirements and implement compliant processes

• Identify gaps and risks; develop mitigation strategies and provide regular status reporting to leadership

• Conduct ongoing readiness reviews, audits, and monitoring activities to ensure sustained compliance

• Collaborate with business areas and cross-functional stakeholders to develop and finalize NCQA data source submission reports (e.g., Member Experience [ME 7]), ensuring accuracy, completeness, and alignment with NCQA standards and audit expectations

• Oversee delegated vendor functions to ensure adherence to NCQA accreditation requirements

• Facilitate cross-functional workgroups, committee discussions, and Quality Improvement meetings to drive accountability and readiness

• Establish and track performance metrics (process, outcome, and compliance measures) and present findings to stakeholders

• Drive continuous improvement initiatives to enhance quality, efficiency, and accreditation outcomes

• Analyze policies, workflows, and documentation to improve effectiveness and ensure regulatory alignment

• Support additional accreditation and compliance initiatives as needed

What You Bring

• Bachelor's degree or equivalent experience

• 3+ years of experience in related field

• In lieu of degree, 5+ years of experience in related field

Bonus Points (preferred qualifications)

• 5+ years of program or project management experience in healthcare, quality, or compliance

• Demonstrated experience preparing for and supporting NCQA surveys, file reviews, and accreditation submissions.

• Strong working knowledge of health plan credentialing operations, delegated credentialing oversight, and provider network compliance requirements.

• Experience leading cross-functional accreditation workgroups and driving corrective action plans through completion.

• Direct experience with NCQA Health Plan Accreditation standards and survey processes

• Experience supporting or managing Credentialing and Recredentialing (CR) activities

• Proven ability to manage cross-functional initiatives and drive results in a matrixed environment

• Strong understanding of accreditation compliance, evidence documentation, and audit readiness

• Ability to assess compliance gaps and implement actionable solutions

• Excellent analytical, organizational, and problem-solving skills

• Strong communication skills with the ability to influence stakeholders at all levels

• Proficiency in Microsoft Excel, PowerPoint, Teams, and SharePoint

• High attention to detail with strong program tracking and reporting capabilities

What You’ll Get

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community  Work-life balance, flexibility, and the autonomy to do great work  

• Medical, dental, and vision coverage along with numerous health and wellness programs  

• Parental leave and support plus adoption and surrogacy assistance  

• Career development programs and tuition reimbursement for continued education  

• 401k match including an annual company contribution  

• Learn more (   

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$73,698.00 - $117,917.00

Skills

Budgeting, Office Administration, Process Improvements, Program Administration, Program Documentation, Program Evaluations, Program Implementation, Program Management, Project Management, Resource Allocation

JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on . If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: View email address on click.appcast.io .

About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.

Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.

Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview ( for English or Visión General de E-Verify ( for Español.

Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at View email address on click.appcast.io .

Blue Cross NC is a Hybrid Flex company. Whether the role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any of our approved states:

Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming