Santa Clara Family Health Plan
Accreditation Program Manager
Santa Clara Family Health Plan - San Jose, California, United States, 95199
Work at Santa Clara Family Health Plan
Overview
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Overview
FLSA Status:
Exempt Department:
Quality Improvement Reports To:
Manager, Process Improvement GENERAL DESCRIPTION OF POSITION
The Accreditation Program Manager is responsible for developing work plans, conducting gap analyses, performing internal audits, reviewing documentation for compliance, and facilitating stakeholder collaboration for program planning and work stream facilitation in support of NCQA accreditation survey readiness. This role involves working collaboratively with internal and external stakeholders, including consultants, auditors, and surveyors, to ensure compliance and improve efficiency at Santa Clara Family Health Plan (SCFHP). Additionally, the manager leads medium to large-scale projects related to accreditation, providing ongoing support to organizational initiatives. ESSENTIAL DUTIES AND RESPONSIBILITIES Lead and organize accreditation activities to achieve and maintain Medicare and Medi-Cal accreditation, including creating, monitoring, and executing project work plans. Serve as the accreditation liaison, collaborating with stakeholders to ensure NCQA compliance. Act as the primary contact with NCQA for policy clarification, survey preparation, and communication. Lead quality and process improvement projects related to accreditation standards. Conduct internal audits to assess readiness and facilitate workgroups to track standards. Support continuous improvement initiatives and streamline audit processes in partnership with Compliance. Define standards for accreditation work and coach staff on their application. Develop and maintain project documentation, including timelines, scope, and work plans. Maintain accreditation program documentation and update as needed. Identify and resolve project issues, escalating critical problems to leadership. Review accreditation standards annually to ensure ongoing compliance. Create training materials for staff regarding accreditation requirements. Communicate project updates and status reports timely. Maintain comprehensive knowledge of NCQA standards and their operational impact. Collaborate with colleagues to improve operational efficiency and develop initiatives. Perform other duties as assigned.
REQUIREMENTS
The following are required (R) and desired (D) qualifications: Bachelors Degree in Management, Business, Healthcare, or related field, or equivalent experience. (R) At least three years of experience in health or managed care with accreditation responsibilities, including one year as a subject matter expert. (R) Minimum two years of project management experience. (R) Effective facilitation and presentation skills. (R) Ability to manage complex, multi-departmental projects. (R) Strong organizational skills and adaptability. (R) Ability to work independently and collaboratively. (R) Strong analytical and problem-solving skills. (R) Knowledge of health plan operations, quality improvement, and IT. (D) Project management certification. (D) Knowledge of process improvement methodologies, Lean, or Six Sigma. (D) Proficiency in MS Office applications and project management tools. (R) Excellent communication skills. (R) Ability to work under pressure and prioritize tasks. (R) Good judgment and decision-making abilities. (R) Ability to maintain confidentiality and adhere to policies. (R) Commitment to safety and respectful work environment. (R)
WORKING CONDITIONS
Primarily office-based, with frequent interactions with staff and stakeholders, often requiring multitasking and interruptions. PHYSICAL REQUIREMENTS
Mobility: Bending, reaching, sitting, standing. (R) Lifting: Up to 5 pounds regularly. (R) Visual: Ability to read printed and digital information. (R) Dexterity: Use of hands and fingers for typing and operating equipment. (R) Hearing/Talking: Communication via speech and listening. (R) Reasoning: Work effectively under pressure, decision-making, attention to detail. (R)
ENVIRONMENTAL CONDITIONS
Standard office environment with moderate noise levels. #J-18808-Ljbffr
Exempt Department:
Quality Improvement Reports To:
Manager, Process Improvement GENERAL DESCRIPTION OF POSITION
The Accreditation Program Manager is responsible for developing work plans, conducting gap analyses, performing internal audits, reviewing documentation for compliance, and facilitating stakeholder collaboration for program planning and work stream facilitation in support of NCQA accreditation survey readiness. This role involves working collaboratively with internal and external stakeholders, including consultants, auditors, and surveyors, to ensure compliance and improve efficiency at Santa Clara Family Health Plan (SCFHP). Additionally, the manager leads medium to large-scale projects related to accreditation, providing ongoing support to organizational initiatives. ESSENTIAL DUTIES AND RESPONSIBILITIES Lead and organize accreditation activities to achieve and maintain Medicare and Medi-Cal accreditation, including creating, monitoring, and executing project work plans. Serve as the accreditation liaison, collaborating with stakeholders to ensure NCQA compliance. Act as the primary contact with NCQA for policy clarification, survey preparation, and communication. Lead quality and process improvement projects related to accreditation standards. Conduct internal audits to assess readiness and facilitate workgroups to track standards. Support continuous improvement initiatives and streamline audit processes in partnership with Compliance. Define standards for accreditation work and coach staff on their application. Develop and maintain project documentation, including timelines, scope, and work plans. Maintain accreditation program documentation and update as needed. Identify and resolve project issues, escalating critical problems to leadership. Review accreditation standards annually to ensure ongoing compliance. Create training materials for staff regarding accreditation requirements. Communicate project updates and status reports timely. Maintain comprehensive knowledge of NCQA standards and their operational impact. Collaborate with colleagues to improve operational efficiency and develop initiatives. Perform other duties as assigned.
REQUIREMENTS
The following are required (R) and desired (D) qualifications: Bachelors Degree in Management, Business, Healthcare, or related field, or equivalent experience. (R) At least three years of experience in health or managed care with accreditation responsibilities, including one year as a subject matter expert. (R) Minimum two years of project management experience. (R) Effective facilitation and presentation skills. (R) Ability to manage complex, multi-departmental projects. (R) Strong organizational skills and adaptability. (R) Ability to work independently and collaboratively. (R) Strong analytical and problem-solving skills. (R) Knowledge of health plan operations, quality improvement, and IT. (D) Project management certification. (D) Knowledge of process improvement methodologies, Lean, or Six Sigma. (D) Proficiency in MS Office applications and project management tools. (R) Excellent communication skills. (R) Ability to work under pressure and prioritize tasks. (R) Good judgment and decision-making abilities. (R) Ability to maintain confidentiality and adhere to policies. (R) Commitment to safety and respectful work environment. (R)
WORKING CONDITIONS
Primarily office-based, with frequent interactions with staff and stakeholders, often requiring multitasking and interruptions. PHYSICAL REQUIREMENTS
Mobility: Bending, reaching, sitting, standing. (R) Lifting: Up to 5 pounds regularly. (R) Visual: Ability to read printed and digital information. (R) Dexterity: Use of hands and fingers for typing and operating equipment. (R) Hearing/Talking: Communication via speech and listening. (R) Reasoning: Work effectively under pressure, decision-making, attention to detail. (R)
ENVIRONMENTAL CONDITIONS
Standard office environment with moderate noise levels. #J-18808-Ljbffr