Create An Account

GENERAL DESCRIPTION OF POSITION The Accreditation Program Manager is responsible for developing work plans, gap analyses, conducting internal audits, reviewing documentation for compliance, and facilitating stakeholder collaboration for all program planning and work stream facilitation in support of National Committee for Quality Assurance (NCQA) accreditation survey readiness. The Accreditation Program Manager is responsible for working collaboratively and cross-functionally with internal and external stakeholders, including consultants, auditors and surveyors to create efficiencies and improvements to meet accreditation standards at Santa Clara Family Health Plan (SCFHP). In addition, the Accreditation Program Manager is responsible for projects assigned, including providing ongoing support to organizational initiatives by leading the analysis and implementation of accreditation related medium to large scale projects and efforts.

ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.

Lead and organize all accreditation activities to achieve and maintain plan accreditation in Medicare and Medi-Cal lines of business including creating, monitoring and executing project work plans and deliverables with business units.

Serve as accreditation liaison, working collaboratively and cross-functionally with internal and external stakeholders to ensure NCQA compliance, including delegates.

Serve as the primary point of contact with NCQA for policy clarification questions, administrative maintenance, payment of invoices, survey preparation and any other communication.

Lead and facilitate medium to large scale quality and process improvement projects by providing direction for project framing, organization, business case analysis, implementation, and outcome/success measurement related to accreditation requirements.

Conduct routine internal audits to assess business unit readiness for document review and onsite file review. Work alongside project managers to facilitate workgroups and track standards deliverables progress.

Drive adoption of continuous improvement across the organization by supporting and coordinating business change initiatives and activities associated with process improvements and system changes to ensure smooth transitions for stakeholders related to accreditation requirements. Partner with Compliance department to streamline internal and external audit and oversight requirements of accreditation.

Define organization standards for consistent approach to accreditation work and coach business partners on application of the standards.

REQUIREMENTS – Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

Bachelor’s Degree in Management, Business, Healthcare, or a related field, or equivalent experience. (R)

Minimum three years of experience in health and/or managed care with responsibility for accreditation including one year of serving as subject matter expert or main point of contact. (R)

Minimum two years of project management experience. (R)

Ability to effectively facilitate meetings and deliver information/presentations. (R)

Ability to organize, plan, direct and manage medium to large scale, complex, cross-functional, multi-departmental projects. (R)

Strong organizational skills; able to adapt to changing environment, work independently, and manage multi-task responsibilities. (R)

Ability to work with a high level of independence with strong collaboration and relationship management skills. (R)

Strong analytical and problem solving abilities (R)

Knowledge of operational areas, quality improvement, IT, and health services in a health plan or integrated delivery system. (D)

Santa Clara Family Health Plan (SCFHP) is a local, community-based health plan dedicated to improving the health and well-being of the residents of Santa Clara County. Working in partnership with providers and community organizations, we serve our neighbors through our Medi-Cal and SCFHP DualConnect (HMO D-SNP) health care plans.