Manager, NCQA

Job Description

Job Description

Do you enjoy healthcare standard work and accreditation activities? Do you want to affect the health outcomes of San Francisco communities?

San Francisco Health Plan (SFHP) has a leadership opportunity for you.

Reporting to Chief Compliance and Regulatory Affairs Officer, the Manager, NCQA is an experienced healthcare professional responsible for managing and leading activities associated with SFHP’s NCQA Accreditation, ongoing monitoring and analysis of plan performance against the NCQA standards, and coordination of all NCQA-related activities across the organization to maintain and prepare for ongoing NCQA accreditation and future categories of NCQA accreditation.

You will also lead essential NCQA submissions and special projects.

Your day-to-day includes interfacing with SFHP internal departments in support of NCQA accreditation standards, serving as the departmental point of contact for all matters related to NCQA accreditation, and managing a staff.

Please note that while SFHP supports a hybrid work environment, this role will be 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 Range : $127,000 to $141,000 annual

WHAT YOU WILL DO :

• Responsible for timely and professional inquiries, submissions and responses to NCQA.
• Responsible for managing and overseeing the work of the NCQA Analyst.
• Leads and coordinates the NCQA-impacted department communications and activities.
• Transitions the organization’s framework from obtaining NCQA accreditation as a project to an ongoing operational effort to maintain NCQA accreditation through the renewal process.
• Manages the overall 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.
• Evaluates, interprets and summarizes accreditation guidelines on at least an annual basis and manage the process for accreditation activities, including communicating the changes in the standards from year-to-year and assist departments with updating policies, procedures, workflows, reports, etc.

to comply with updated standards.

• Identifies appropriate resources and accountabilities within departments involved with accreditation and ensures engagement by all impacted departments.
• Leads coordination and communication with NCQA consultant as needed.
• Conducts the ongoing evaluation and interpretation of accreditation standards to ensure compliance through department leads, reporting and measurement studies / methodologies.
• Serves as expert resource to internal staff across the organization.
• Facilitates project management and develops comprehensive accreditation work plans by establishing deliverables, accountabilities, and timelines.
• Works in collaboration with the Compliance team to monitor activities for compliance with NCQA standards in conjunction with compliance activities related to compliance with state regulatory and contractual requirements.
• Timely informs and trains staff on changes in NCQA accreditation standards and tools.
• Appropriately refers substantive questions, key business issues to subject matter experts and follows up to ensure resolution, and escalates as needed.
• Assesses problems and develops solutions following general policies and procedures and escalates to manager as appropriate.
• Assists manager with budget related to NCQA expenses, including processing invoices and variance reports.
• Leads efforts to manage projects for the implementation of DHCS and DMHC All-Plan Policy letters on an as-needed basis.

WHAT YOU WILL BRING :

• Bachelor’s degree in a related field or equivalent work experience
• 3-5 years of health care-related experience
• 3-5 years of management experience, leading and coaching teams.
• Project management experience
• Successful NCQA accreditation process completion and continuous process improvement experience in an NCQA setting highly preferred.
• Experience analyzing and providing guidance on studies that go along with NCQA required.
• Possesses a strong quality improvement background that includes managed care and NCQA, specifically within the Medicaid and government-sponsored programs environments.

WHAT WE OFFER :

A competitive and robust compensation package, including :

• Health benefits
• Medical : You’ll have a choice of medical plans, including options from Kaiser and Blue Shield of California. Employee-only coverage in the HMO plans is currently available at no cost and dependent coverage is 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.

An opportunity to work in a vibrant atmosphere with the most amazingly talented people who are shaping the future of healthcare!

The chance to make a difference in the lives of many San Francisco residents!

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.

SFHP was designed by and for the residents it serves and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.

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.