Program Manager, NCQA

NCQA Program Manager

Reporting to the Director, Regulatory Affairs, the NCQA Program Manager is an experienced healthcare professional. You will manage and lead activities associated with SFHP's NCQA Accreditation. These activities include ongoing monitoring and analysis of plan performance against the NCQA standards. Additionally, the manager coordinates all NCQA-related activities across the organization. The goal of these efforts is to maintain and prepare for ongoing NCQA accreditation and future categories of NCQA accreditation.

Position activities involve frequent daily interface with SFHP internal departments to support NCQA accreditation standards. Be the departmental contact for all matters related to NCQA accreditation. We are looking for someone who can manage a dynamic workload and adapt to evolving needs. And works independently while also motivating and supporting others.

Please note that while SFHP supports a hybrid work environment, you are required to be onsite and in-office a minimum of 4 days per month. This is a hybrid position, based in our Downtown San Francisco office.

Salary: $90,000 - $105,000 per year

What You Will Do:

• Responsible for project timelines and professional inquiries, submissions and responses to NCQA.
• Lead the NCQA-impacted department communications and activities.
• Transition our framework from obtaining NCQA accreditation as a project to an ongoing operational effort to maintain NCQA accreditation through the renewal process.
• Manage the accreditation processes and resources required to renew SFHP's accreditation status, including working with staff to ensure the submission of HEDIS and CAHPS data for the renewal survey.
• Evaluate, interpret, and summarize accreditation guidelines at least annually. Manage the process for accreditation activities, including communicating year-to-year changes in the standards. Assist departments with updating policies, procedures, workflows, and reports, and to comply with updated standards.
• Identify appropriate resources and accountabilities within departments involved with accreditation and ensure engagement by all impacted departments.
• Lead coordination and communication with NCQA consultants.
• Conduct the ongoing evaluation and interpretation of accreditation standards to ensure compliance through department leads, reporting and measurement studies/methodologies.
• Be an expert resource to internal staff across the organization.
• Facilitate project management and develop comprehensive accreditation work plans by establishing deliverables, accountabilities, and timelines.
• Work in collaboration with the Compliance team to monitor activities for compliance with NCQA standards together with compliance activities related to compliance with state regulatory and contractual requirements.
• Inform and train staff on changes in NCQA accreditation standards and tools.
• Refer substantive questions, important business issues to subject matter experts and follow up to ensure resolution and escalate.
• Assess problems and develop solutions following general procedures and escalate to manager.
• Assist manager with budget related to NCQA expenses, including processing invoices and variance reports.
• Lead efforts to manage projects for implementing DHCS, CMS, and DMHC All-Plan Policy letters on an as-needed basis.

What You Will Bring:

• Bachelor's degree or equivalent work experience
• 3 or more years of experience in project management
• Successful NCQA accreditation process completion and continuous process improvement experience in an NCQA setting
• Experience analyzing and providing guidance on studies that go along with NCQA
• Possess a strong quality improvement background that includes managed care and NCQA, specifically within the Medicaid and government-sponsored programs environments.

What We Offer:

• Health Benefits
  • Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.
  • Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
  • Vision: Employee vision care coverage is available through Vision Service Plan (VSP).
• Retirement – Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.
• Time off – 23 days of Paid Time Off (PTO) and 13 paid holidays.
• Professional development: Opportunities for tuition reimbursement, professional license/membership.

About SFHP:

Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services.

San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.

Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.