NCQA Compliance Program Manager

We have an exciting opportunity to join the Alliance as a NCQA Compliance Program Manager in the Compliance Department. 

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Compliance Director, this position: 

• Will act as the Compliance Division’s National Committee on Quality Assurance (NCQA) compliance subject matter expert
• Perform program planning and design in support of the implementation, on-going management, and oversight of the Alliance’s NCQA Compliance Program
• Guide and supports Alliance departments in maintaining compliance with NCQA requirements
• Perform other duties as assigned

ABOUT THE TEAM

The Compliance Division interprets requirements, mitigates risk, and holds stakeholders accountable, protecting the organization’s integrity and member access to quality healthcare. We help Alliance staff understand and follow compliance-related health care laws, contracts, and regulations so that we can all do our part to meet the Alliance’s obligations as a taxpayer-funded health plan. We share our knowledge across the organization through compliance rules, policy, and documents.

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here. 

• Knowledge of:
• The principles and practices of program development, implementation, management, and evaluation
• Thorough knowledge of research, analysis, and reporting methods
• The principles and practices of managed care and the Medi-Cal and/or Medicare Programs and related regulations
• Auditing and monitoring practices and techniques
• Ability to:
  • Learn, synthesize, communicate, and apply NCQA specific requirements
  • Act as a technical resource and clearly and concisely explain complex laws, regulations, processes, and programs related to areas of responsibility
  • Demonstrate strong analytical skills, accurately collect, manage and analyze data, identify issues, offer recommendations and potential consequences, and mitigate risk
  • Take initiative to address problems and make continuous process improvements
• Education and Experience:
  • Bachelor’s degree in Business, Health Care Administration, Public Policy, or a related field
  • Minimum of eight years of experience in a health care setting which included a minimum of five years of experience performing program development and management including some experience developing program audits and performing program auditing (a Master’s degree may substitute for two years of the general managed care experience); or an equivalent combination of education and experience may be qualifying

OTHER INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below. 

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

Last updated on Aug 15, 2024