Job Description
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.
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 - $117,917.00Skills
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: .
Originally posted on Himalayas
