Senior Quality and Accreditation Consultant--Health Equity

at  CAPITAL BLUE CROSS

Position Description:
At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”
The NCQA Senior Health Equity Consultant, as part of the Quality & Accreditation team, will have responsibility for the development of an actionable framework for creating the structures and processes to begin working toward addressing health equity. The individual will assist with the scheduling and facilitation of a consultative call with a NCQA program expert and a gap analysis. This individual will focus on the foundation of health equity and help build a culture that supports Capital’s external health equity work such as collecting data that help the organization create and offer language services, provider networks mindful of individuals’ cultural and linguistic needs, and identifying opportunities to reduce health inequities and improve care. This individual will provide leadership and direction to various areas throughout the organization related to Capitals desire to achieve and maintain health equity certification.
The NCQA Health Equity Consultant will help develop key performance metrics in alignment with industry standards to demonstrate the effectiveness of initiatives, processes, and will monitor these to ensure compliance with all regulatory requirements. They will actively work with external consultants, as well as support submission of required documents to all state and accreditation entities.

Responsibilities and Qualifications:

• Take the lead in implementing and evolving Capital’s health equity accreditation readiness, ensuring that our organization is at the forefront of addressing health equity.
• Ensure compliance and readiness throughout the multi-year project life cycle, including creating project plans, managing resources, and facilitating project execution, deployment, and closure in accordance with NCQA requirements.
• Responsible for end-to-end accreditation activities for the Plan, including coordination with multidisciplinary interdepartmental teams, audit of compliance standards, and comprehensive analyses to meet NCQA requirements.
• Serve as a subject matter expert for health equity NCQA accreditation, providing in-depth knowledge and guidance to ensure compliance and success.
• Create and collect all documentation required to meet NCQA HE Standards.
• Work with the plan and consultants to ensure all standards are understood and met.
• Perform audits for compliance – complete reports and analyses in support of accreditation standards.
• Collaborate with internal/external stakeholders and vendors to resolve issues and execute mitigation plans.
• Take ownership of designing, managing, and monitoring key performance reports that not only meet regulatory requirements but also align with industry standards, providing valuable insights for decision-making.
• Ensure performance reports include key metrics to demonstrate the effectiveness of all processes, initiatives, and vendor relationships.
• Present periodic status updates to executive leadership.
• Provide leadership and response to all inquiries related to accreditation, including but not limited to inquiries from the Capital executive team and/or Board.
• Provide leadership and response to inquiries from NCQA, FEPDO, the Pennsylvania Insurance Department, the Department of Health, etc.
• Monitor developing trends and enhance knowledge in health equity accreditation.
• Stay up-to-date with NCQA standards and processes by actively participating in industry conferences and events, ensuring a broad knowledge base and ongoing successful accreditation status.
• Develop training materials and presentations.
• Assess and monitor the need for training and education of internal and external stakeholders with regard to accreditation.

SKILLS:

• Superior cross-functional collaboration and people management skills
• Ability to plan, organize, lead, and control projects and work teams.
• Demonstrated ability to drive results to completion while managing multiple projects and priorities competing for resources.
• Ability to complement leadership and other team members in their responsibilities and roles.
• PC literacy and ability to perform electronic research and respond to electronic requests.
• Team oriented attitude with the ability to work and interact with all levels both within and outside of Capital Blue Cross
• Demonstrated organizational and time management skills.
• Demonstrated strong oral, written, and presentation skills; ability to convey complex or technical information in a manner that others can understand.
• Proven problem-solving skills; the ability to systematically analyze problems, draw relevant conclusions, and devise appropriate courses of action.
• Ability to appreciate and pursue strategic direction as well as develop tactical plans and drive performance.

KNOWLEDGE:

• Proficient in understanding healthcare system operations
• Familiarity with regulatory requirements including but not limited to NCQA, CMS, PA state law and mandates.

EXPERIENCE:

• Minimum of 5 years’ experience in a healthcare / health plan setting
• Familiarity with regulatory requirements including but limited to NCQA, CMS, PA state law and mandates, as well as knowledge of NCQA and health equity accreditation requirements.

EDUCATION AND CERTIFICATIONS:

• Bachelor’s degree (or equivalent experience) in a health-related field and /or an active health care licensure.
• Six Sigma certification preferred.
• Must maintain a valid Pennsylvania driver’s license.

• Take the lead in implementing and evolving Capital’s health equity accreditation readiness, ensuring that our organization is at the forefront of addressing health equity.
• Ensure compliance and readiness throughout the multi-year project life cycle, including creating project plans, managing resources, and facilitating project execution, deployment, and closure in accordance with NCQA requirements.
• Responsible for end-to-end accreditation activities for the Plan, including coordination with multidisciplinary interdepartmental teams, audit of compliance standards, and comprehensive analyses to meet NCQA requirements.
• Serve as a subject matter expert for health equity NCQA accreditation, providing in-depth knowledge and guidance to ensure compliance and success.
• Create and collect all documentation required to meet NCQA HE Standards.
• Work with the plan and consultants to ensure all standards are understood and met.
• Perform audits for compliance – complete reports and analyses in support of accreditation standards.
• Collaborate with internal/external stakeholders and vendors to resolve issues and execute mitigation plans.
• Take ownership of designing, managing, and monitoring key performance reports that not only meet regulatory requirements but also align with industry standards, providing valuable insights for decision-making.
• Ensure performance reports include key metrics to demonstrate the effectiveness of all processes, initiatives, and vendor relationships.
• Present periodic status updates to executive leadership.
• Provide leadership and response to all inquiries related to accreditation, including but not limited to inquiries from the Capital executive team and/or Board.
• Provide leadership and response to inquiries from NCQA, FEPDO, the Pennsylvania Insurance Department, the Department of Health, etc.
• Monitor developing trends and enhance knowledge in health equity accreditation.
• Stay up-to-date with NCQA standards and processes by actively participating in industry conferences and events, ensuring a broad knowledge base and ongoing successful accreditation status.
• Develop training materials and presentations.
• Assess and monitor the need for training and education of internal and external stakeholders with regard to accreditation