Manager, NCQA

Company: San Francisco Health Plan
Location: San Francisco
Posted on: March 23, 2025

Job Description:

Reporting to the Chief Compliance and Regulatory Affairs Officer, the NCQA Manager is an experienced healthcare professional responsible for 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. You will maintain a culture of NCQA accreditation throughout the year and prepare for ongoing NCQA accreditation and future categories of NCQA accreditation. You will lead NCQA submissions and special projects. You will manage an NCQA analyst and work with NCQA leads across the organization.Please note that while SFHP supports a hybrid work environment, you are 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: $131,000 to $154,000 per year.WHAT YOU WILL DO:

• Responsible for inquiries, communication, submissions and responses to and from NCQA.
• Responsible for guiding and managing the work of the NCQA Analyst.
• Lead the NCQA-impacted department communications and activities.
• Transition SFHP's framework from obtaining NCQA accreditation as a project to an ongoing operational effort to maintain an NCQA accreditation culture during off-cycle years and through the renewal process.
• Manage the accreditation processes and resources required to renew SFHP's accreditation, including working with staff to ensure the submission of HEDIS and CAHPS data for the renewal survey.
• Evaluate, interpret, and communicate accreditation standards and guidelines.
• Communicate the changes in the standards from year-to-year and assist departments with updating policies, procedures, workflows, and reports.
• Identify appropriate resources and accountabilities within departments involved with accreditation and ensure engagement by all impacted departments.
• Lead coordination, management, and communication with NCQA consultants.
• Conduct the ongoing evaluation and interpretation of accreditation standards to ensure compliance.
• Facilitate project management and develop comprehensive accreditation work plans.
• Work in collaboration with the Compliance team to monitor activities for compliance with NCQA standards.
• Train staff on changes in NCQA accreditation standards and tools.
• Lead efforts to manage projects for implementing DHCS and DMHC All-Plan Policy letters on an as-needed basis.WHAT YOU WILL BRING:
  • Bachelor's degree in Business, Public Health, Policy, or other related field; or equivalent work experience
  • 3 or more years of experience, leading and coaching teams
  • 3 or more years of health care related experience in successful NCQA accreditation process completion and improvement
  • Experience analyzing and providing guidance on studies that go along with NCQA
  • Quality improvement background that includes managed care and NCQA, specifically within the Medicaid and government-sponsored programs environmentsWHAT WE OFFER:
    • Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, 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.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.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.
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Keywords: San Francisco Health Plan, San Francisco , Manager, NCQA, Executive , San Francisco, California