Apply online at http://www.alohacare.org/Careers/Default.aspx

The Company:

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.

The Culture:

AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.

AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.

These employee-focused efforts contribute to a friendly, team-oriented culture, which is positively reflected into the communities we serve.

Position Summary:

Under the direction of the Senior Vice President, Compliance and Quality, the Senior Manager, NCQA Accreditation manages the development, implementation, and execution of the program plan necessary to meet all National Committee for Quality Assurance (NCQA) Health Plan Accreditation (HPA) and NCQA Health Equity Accreditation (HEA) and certification requirements. The Senior Manager collaborates with Directors and Managers across the organization to ensure that policies, procedures, reports and applicable activities comply with regulations and accreditation standards and that standards are fully met. As the Subject Matter Expert (SME), the Senior Manager continuously educates and trains staff as they implement relevant processes, reports, and/or activities related to both NCQA accreditation programs.

Primary Job Duties and Responsibilities:

NCQA Accreditation – Health Plan Accreditation and Health Equity Accreditation

• Serves as primary contact and liaison between NCQA, NCQA consultants and AlohaCare.
• Develop and execute organization work plans/NCQA trackers to achieve both NCQA HPA and HEA accreditation designations; coordinates NCQA survey activities and ensuring ongoing compliance with NCQA accreditation standards.
• Identify gaps and risks; providing regular status reports from NCQA trackers to appropriate management and developing strategies to mitigate risks and gaps considering business needs and compliance requirements.
• Serve as AlohaCare’s subject matter expert on NCQA Health Plan Accreditation and Health Equity Accreditation and standard interpretation; collaborating with clinical trainer and managers on educating relevant managers and staff on standards and assist with operationalizing requirements.
• Manage and oversee preparation for NCQA site visits and surveyor activities including, maintaining NCQA Interactive Review Tools (IRTs) , completing applications, preparatory audits, mock reviews and documentation.
• Work within organizational wide, cross-functional and multi-disciplinary teams to bring each business area to a state of readiness, ensuring all NCQA compliance issues are addressed and Plans of Correction in partnership with Compliance, are completed timely and noted on NCQA tracker.
• Conduct ongoing NCQA HPA and HEA readiness monitoring and auditing activities utilizing the NCQA tracker to identify risks and assist department Managers/Directors, and Executive Council (EC) leaders with corrective actions to ensure continuing compliance with NCQA standards.
• Work with the Chair(s) of Corporate Quality Improvement Committee (CQIC), Practitioners Advisory Committee (PAC), and any other standing or ad-hoc committee in ensuring that the process of approvals follow NCQA requirements.
• Develop a communication plan for all staff, managers, and executives to educate on NCQA standards changes and updates, as needed.
• Recommend policies and procedures specific to NCQA to the applicable Managers/Directors/EC leaders to ensure alignment and compliance with NCQA standard requirements.
• Assist applicable Managers/Directors/EC leaders in developing, prioritizing, and managing the programmatic and policy components, operational activities on the NCQA Policy tracker of organization-wide projects and/or initiatives as they relate to initiatives, compliance and accreditation.
• Attend NCQA presentations and other national informational programs (such as Associated For Community Affiliated Plans, America’s Health Insurance Plans), as necessary to maintain expertise.
• Ensure that possible or actual differences -- between NCQA standards and the requirements of QUEST Integration, CMS, and other regulatory requirements, as well as AlohaCare’s policies & procedures -- are addressed and reconciled.
• Train Compliance staff on NCQA standards that apply to their particular area of responsibility, enabling them to reinforce importance of compliancy.
• Manage, facilitate, and complete regulatory accreditation reports.

Supervisory Duties:

• Performs general management duties to include: the hiring process, training, work assignments, performance evaluations, development of career goals, and disciplinary action.
• Provides timely guidance and feedback to help staff strengthen specific knowledge and develop skill areas to accomplish tasks or solve problems.

Required Competencies & Qualifications:

• Bachelor’s Degree or equivalent combination of demonstrated experience and education.
• 5 years of NCQA accreditation management experience and/or relevant audit, program or project management experience
• 3 years leadership/management experience
• Knowledgeable of NCQA accreditation process and standards
• Working knowledge of Medicaid and/or Medicare
• Demonstrated success with Business Process Improvement and Workforce Effectiveness projects.
• Demonstrated ability to effectively prioritize and execute tasks and special projects.
• Demonstrated experience in data collection, presentation and action plans.
• Strong verbal and written communication skills
• Intermediate to Advanced skills in Microsoft Office (Word, Excel, PowerPoint, Outlook)
• Maintains stable performance under pressure or opposition (such as approaching deadlines or job ambiguity); handles stress in a manner that is acceptable to others and to the organization.
• Is comfortable with meeting individuals via teleconference forums, as well as interacting and engaging in those forums.

Preferred Competencies & Qualifications:

• 3 years supervisory experience
• Working knowledge of Hawaii QUEST Integration Program
• Experience in conducting and/or directing comprehensive and extensive grievance/appeals investigations.

Physical Demands/Working Conditions:

• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.
• Remote Work: Be available during AlohaCare’s business hours (Hawaii time). Able to fly to Hawaii for audits and audit preparation.

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.