Manager, Program Integrity

NCQA is hiring a Manager of Program Integrity! This position manages the Complaints and Annual Attestation processes, and assists with Investigations, Reconsiderations and other Program Integrity (PI) activities. The position is responsible for project management, report production, and process improvement duties for the PI unit. The position maintains a positive and constructive relationship with internal and external customers to drive operational efficiency and ease of working with the unit.

Responsibilities

Working with PI and Policy Leadership on all PI activities (e.g., Complaints, Reportable Events, Investigations, Reconsiderations, Discretionary Reviews):

Consistently monitor and report on all types of Program Integrity open cases. This includes:

Identifying cases.

Researching and assessing information for cases.

Associated customer follow-up and reporting timelines / due dates.

Team communication to ensure timely actions and reporting within established timelines.

Ongoing dashboards and reports related to cases.

Proactively communicate upcoming activities, needed actions and status updates to stakeholders.

Prepare reports and materials to support PI activities.

Conduct analysis to identify trends, risks and opportunities for improvement.

Maintain positive, collaborative relationships.

Assist in the improvement of processes, systems and services.

Improve operational workflow and enhance reporting capabilities (Salesforce, Excel, SharePoint, Smartsheet).

Participate in development of internal process documents, including policies, workflow diagrams etc. to support new or re-designed operational processes.

Maintain operational reporting and documents on SharePoint.

Work with other staff to identify opportunities to improve our ability to meet customers’ requirements in an easy and efficient manner.

Organize implementation of improvement actions and monitor through completion.

Administer training in PI processes (e.g., Complaints process) to internal stakeholders.

Manage the annual customer attestation process and Complaints process.

Conduct all relevant communications.

Analyze and independently resolve cases that meet criteria.

Prioritize cases that require additional levels of review.

Monitor and report on cases.

Requirements

Bachelor's degree and 2+ years of progressive experience in an administrative, project management, or process improvement environment.

Advanced Word, Excel, PowerPoint, Acrobat skills.

Project management skills.

Flexibility, adaptability and initiative.

Excellent interpersonal, oral and written communication skills, including spelling, grammar, and proofreading skills.

Excellent organizational skills.

Must be able to manage multiple concurrent projects.

Compensation & Benefits:

For new hires, this position pays in the range of $80K - $90K per year, depending on experience.

This position is eligible for an annual incentive bonus, payable in accordance with policy.

Click here for employee benefit information.

NCQA is committed to being an employer of choice and fostering an inclusive culture and workplace.

We are an Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

NCQA is a drug free workplace. NCQA recruits, hires, trains and promotes individuals, and administers any and all personnel actions, without regard to race, color, religion, national origin, age, sex, pregnancy, citizenship, familial status, disability status, veteran status, genetic information, or other protected statuses under applicable state and federal laws.

NCQA will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c).