The Vice President of Compliance will be the subject matter expertise (SME) on the NCQA accreditation process and will help the health plan prepare for the HPA survey and develop an implementation plan for execution. Through on-site guidance and leadership, the team will work collaboratively with health plan client to prepare for the pending NCQA accreditation and ensure an implementation strategy and plan is in place.
- Based upon a “gap analysis”, develop a detailed project plan for the NCQA HPA process including key milestones and activities required. This includes all six areas of 2020 HPA accreditation: Quality Management and Improvement, Utilization Management, Population Health Management, Credentialing, Network Management, and Member Experience (with Medicaid Deeming as an option)
- Inform and jointly define processes for health plan to conduct ongoing evaluation and interpretation of quality and accreditation standards to ensure compliance and a state of continual survey readiness
- Create work plan to attain NCQA accreditation over the next 18-24 months
- Identify and create a plan to develop required policies and procedures needed to support NCQA accreditation standards
- Provide advisory and guidance through the initial hiring process
- Serve as NCQA expert SME through the development process
- Strategic consultation from NCQA SMEs
- Gap analysis to inform the development of the policies and procedures and workflow processes
- Identification and high-level outline of policies, procedures and processes specific to NCQA accreditation that must be developed in order to become certified (development of policies and procedures to be completed in a future work stream if client wishes to proceed)
- Detailed work plan to outline the steps/processes needed to attain Health Plan NCQA Accreditation
- Development of and assistance with implementation of NCQA HPA project plan, key milestones and timeline
- Detailed resource list of all the FTE’s required to attain Health Plan NCQA Accreditation
- Initial Program Descriptions for the major functions: UM, CM, Credentialing, QI, Network, Member Experience and Population Health
- Assistance in the hiring process for the initial management staff for each of the major functions with position description
- Work plan to transition out-sourced functions back into the health plan and determination of which functions should remain out sourced
- Bachelor’s degree in Business or related field. 10 to 15 years of related experience and 8 to 10 years of increasingly responsible management experience; or an equivalent combination of education, health care, or health insurance management experience with increasing management responsibilities.
- Must be able to travel 75% of time to and from the client site (if not located near client site)
- In addition, at least 5 years’ experience in the oversight of Medicare related programs in a health plan/payer environment, with thorough knowledge of NCQA Accreditation
- Management experience in managed care operations.
- Proven ability to lead with an equal balance of strategic agility and execution rigor.
- Demonstrated leadership effectiveness in both formal and influencer roles; dynamic leader that motivates and inspires teams to achieve challenging targets.
- Must possess superior management, negotiation and analytical skills.
- Requires the ability to develop and maintain strong internal and external relationships.
- Must possess excellent verbal and written communications skills.
Job Types: Full-time, Contract
Salary: $180,000.00 to $220,000.00 /year
- Compliance Management: 5 years (Required)
- Management: 6 years (Required)
- Health Plan: 5 years (Required)
- Health insurance
- Dental insurance
- Vision insurance
- Retirement plan
- Paid time off
This Job Is Ideal for Someone Who Is:
- Dependable -- more reliable than spontaneous
- Adaptable/flexible -- enjoys doing work that requires frequent shifts in direction
- Detail-oriented -- would rather focus on the details of work than the bigger picture
- Innovative -- prefers working in unconventional ways or on tasks that require creativity
- High stress tolerance -- thrives in a high-pressure environment