NCQA Manager, Bakersfield, CA

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NCQA Manager

Kern Family Health Care, 2900 Buck Owens Blvd., Bakersfield, California, United States of America Req #1998

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).

KHS reasonably expects to pay starting compensation for the position of NCQA Manager in the range of $100,591 – $130,992 annually.

Our Mission. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.

Primary Purpose

Under the direction of the Director of Quality Improvement, the NCQA and Regulatory Oversight Manager leads oversight and successful completion of initial and renewal accreditation with NCQA. This role ensures ongoing alignment with NCQA accreditation standards by all KHS Departments and compliance with State regulations within KHS Quality Improvement Department. The NCQA Manager is actively involved in the development of policies and procedures for accreditation and the survey process, as well as ones for compliance with State regulations. The manager incorporates feedback into policies, procedures, program documents, and work flows for new NCQA standards. State regulations impacting the QI Department.

This position will lead planning and management of project activities and tasks related to various NCQA accreditation and State regulations or contractual requirements. Under the supervision and direction of the Director of Quality Improvement the NCQA Manager oversees the development, implementation, and coordination of systems and processes necessary to meet all National Committee for Quality Assurance (NCQA) accreditation requirements, State certification for a Medicare D-SNP model of care, and compliance with State requirements for the Quality Program. . Additionally, the NCQA Manager will work on creating quality improvement initiatives across business areas within KHS to achieve regulatory compliance.

Distinguishing Characteristics

• Coordinates the readiness and preparation for the survey, licensing, and certification activities.
• Collaborating with the Director of Quality and identifying opportunities for improvement with the organization and healthcare system
• Evaluating requirements related to applicable accreditation and regulatory agencies and patient safety practices and outcomes.
• Leading in activities that prepare the organization for regulatory accreditation.
• Develops and manages a functional, on-going mechanism to determine compliance with NCQA accreditation standards and State contractual requirements. Provides recommendations for improvement in operational processes.
• Developing information and education materials regarding NCQA accreditation standards and regulatory compliance and patient safety to communicate throughout the system.
• Providing support to KHS or consultative services towards meeting standards of accreditation, performance improvement for organizational compliance
• Keeps industry knowledge up to date and implements and/or disseminates the accreditation, regulatory and/or quality information in a timely manner.
• Serves as point of contact, coordinating and collaborating with NCQA accreditation entities and business partners to ensure compliance with accreditation and regulatory requirements.
• Serves as the Subject Mater Expert (SME) for applicable NCQA accreditation standards.
• Develops tools that assist in determining exposure to accreditation or regulatory compliance risks and identifies opportunities to manage and mitigate those risks.
• Compiles information related to quality improvement and accreditation monitoring activities for internal use and external audits and maintains relevant records.

Supervises

Yes

Essential Functions

• Manages a team of one or more staff.
• Monitors improvement action plans relating to accreditation compliance.
• Works with business management areas to develop metrics for monitoring program objectives and policies and procedures that support compliance with accreditation requirements.
• Responsible for the maintenance of the electronic distribution and housing of all related accreditation, regulatory and contractual documents.
• Provides guidance and input to business unit audit functions to ensure ongoing accreditation and quality compliance.
• Makes recommendations to business unit partners for improvements or remediation to accreditation or regulatory compliance issues.
• Monitors development and use of metrics for accreditation compliance and required quality improvement activities.
• Collaborates with quality teams, utilization management teams, call centers and other departments on accreditation and quality improvement initiatives.
• Provides primary support for quality committee activities.
• Assists with new hires, training, and coaching of direct line staff as well as NCQA accreditation orientation for new KHS staff.
• Participates in the budget process as needed.
• Leads and manages multiple, complex projects for a multi-faceted programs associated with Health Plan and Health Equity Accreditation and State contractual requirements.
• Ability to work through details while keeping a strategic focus.
• Individual contributor who works in a team environment comprised of project managers, program managers, and compliance specialists.
• Proactively supports and reports out to Executive leadership team.
• Ensures quality compliance with accrediting standards for all quality contractual obligations and accreditations with National Committee on Quality Assurance (NCQA), California Department of Health Care Services (DHCS), California Department of Managed Health Care (DMHC), Centers for Medicare and Medicaid (CMS), and others.
• Supports external quality review organization audits, and applicable State government compliance audits relating to delegated oversight, and quality management functions.
• Collaborates with various departments on improvement initiatives.
• Supports Director of Quality Improvement and QI team to plan, convene and facilitate various Quality Improvement (QI) committees and work groups, driving concise agendas to desired outcomes (based on accreditation requirements) and ensuring effective documentation of meeting minutes.
• Acts as key contact for accreditation readiness committee(s) and working subgroup contributors.
• Ensures that the accreditation readiness program is in place by coordinating 'mock surveys' and collecting required supporting documentation, data and action plans.
• Maintains liaison relationship with peers and affiliates by coordinating periodic (quarterly) joint sessions/meetings of key KHS department leaders.

Core Competencies/Knowledge & Skill Requirement

• Experience with formulating an accreditation budget.
• Leadership, project and resource management skills to effectively coordinate and motivate accreditation staff at the Plan level.
• Staff leadership and management experience leading to high functioning team performance.
• Advanced analytical skills with the ability to analyze and interpret data and conduct complex analysis.
• Utilizes effective conflict management skills to manage competing interests and navigate difficult solutions including the ability to negotiate outcomes to ensure NCQA compliance.
• Self-motivated and detail oriented
• Strong computer skills
• Proficiency with the use of a variety of software applications (e.g., Microsoft Project, Word, Excel, Visio, and PowerPoint)
• Ability to use analytical thinking to make critical decisions and solve business problems.
• Strong interpersonal skills highlighting communications excellence and professionalism.
• Effective team working abilities.

Employment Standards

Education:

• Bachelor’s Degree in Public Health, Health Administration or Business Administration, Nursing required, or
• 3 years of demonstrated performance in program development and implementation using quality improvement methodologies/programs and health information technology.

Experience:

• 3 years’ combined experience in operations, quality assurance or quality management
• 1 years’ experience with accreditation and licensing survey preparation activity in a health care setting desired.
• 1 year experience managing a team of staff.
• Knowledge and experience with Federal and State regulatory agencies and requirements (such as CMS, DHCS, and DMHC)
• Knowledge of Managed Medi-Cal, Medicare, and Health Systems organizations
• Experience with quality requirements related to accreditation standards across health plan organizations, certification, and compliance for programs.

Other

• Possession of valid California Driver’s License and proof of valid State required auto liability insurance. (E) Required travel up to 20%
• Bilingual (English/Spanish) desired
• Certified Professional in Healthcare Quality and/or Advanced certification by Academy for Healthcare Management desired.
• Position is based in KHS’ office.

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.

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