About the RoleThe Program Manager II, Accreditation and Regulatory Management (ARM) independently manages assigned projects, standards, and workstreams that support CHPW's ongoing compliance with National Committee for Quality Assurance (NCQA) accreditation requirements. This position partners with CHPW business teams to translate accreditation requirements into actionable work plans, monitor readiness, conduct compliance reviews, identify and communicate risk, and support timely resolution of identified gaps. This position serves as a subject matter expert for assigned accreditation areas and provides reliable guidance and project oversight to help business teams meet established requirements. The role supports accreditation surveys and continuous readiness activities while escalating significant compliance risks and organizational barriers to leadership.
To be successful in this role, you:- Possess a bachelor's degree in health care administration, public health, business administration, quality management, or a related field, or an equivalent combination of education and highly relevant experience.
- Have a minimum of 3 (three) years of experience managing projects or programs, preferably in a health plan, health care, quality, compliance, or accreditation environment.
- Have experience partnering with cross-functional business owners to interpret requirements, establish deliverables, monitor progress, and address barriers.
- Have experience conducting compliance reviews, audits, readiness assessments, file reviews, or similar evaluative work.
- Have experience developing work plans, tracking risks and dependencies, communicating status, and managing work through completion.
- Have experience researching and applying accreditation, regulatory, contractual, or organizational requirements.
- Have experience identifying process improvement opportunities and supporting implementation of improved or standardized processes.
- Have knowledge of NCQA accreditation standards, managed care operations, and health plan regulatory requirements, preferred.
Essential functions and Roles and Responsibilities:- Independently manages assigned NCQA accreditation projects, standards, survey components, and recurring workstreams by developing work plans, establishing milestones, tracking dependencies and risks, and communicating progress toward established goals.
- Partners with assigned business owners to translate assigned NCQA standards into clear deliverables, evidence requirements, and readiness activities; provides consultation and maintains accountability for timely completion of assigned work.
- Conducts compliance reviews of files, records, reports, and other supporting documentation, and conducts audits and oversight activities across assigned accreditation, operational, or delegated areas to assess compliance, identify issues, and support corrective action or process improvement.
- Monitors identified compliance gaps, corrective actions, performance, and readiness within assigned accreditation areas through resolution; works with responsible business owners to address barriers, identifies trends and improvement opportunities, supports process improvements, and escalates overdue, insufficient, or high-risk items to ARM leadership.
- Serves as a subject matter expert for assigned accreditation standards, projects, or functional areas; researches requirements, provides guidance, and escalates complex, novel, or high-risk interpretation questions as appropriate.
- Leads assigned accreditation project meetings and cross-functional workgroups by establishing objectives, facilitating discussion and decisions, confirming responsibilities, and monitoring completion of deliverables.
- Drafts or supports updating assigned policies, procedures, reports, narratives, training materials, tools, and other accreditation documentation for review and approval.
- Develops and delivers training and technical guidance to business owners and other stakeholders regarding assigned NCQA requirements, accreditation processes, evidence expectations, and readiness activities.
- Represents CHPW in assigned accreditation activities, reviews, workgroups, or external discussions within the scope of the role.
- Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.
Knowledge, Skills, and Abilities:- Ability to interpret data, identify trends, and use data insights to support reporting, monitoring, and decision-making.
- Knowledge of health plan accreditation, regulatory compliance, and quality-management principles.
- Ability to research, interpret, and apply detailed requirements to organizational operations and evidence.
- Advanced project-management skills, including planning, tracking, risk identification, stakeholder coordination, and status communication.
- Advanced compliance-review, analytical, critical-thinking, and problem-solving skills.
- Ability to evaluate documentation and operational evidence, identify gaps, and communicate clear and actionable findings.
- Effective written and verbal communication skills, including the ability to comprehend and explain complex requirements to varied audiences.
- Advanced interpersonal and facilitation skills that support collaborative relationships and accountability across business teams.
- Demonstrated organizational, time management, and project management skills.
- Demonstrated efficiency in business software programs such as Microsoft Office including: Word, Power Point, Outlook, Excel, and Access.
- Ability to work independently and multi-task, deal with complexity on a frequent basis.
As part of our hiring process, the following criteria must be met:- Complete and successfully pass a criminal background check.
- Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant's criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.
- Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
- Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.
Compensation and Benefits:The position is FLSA Exempt and is not eligible for overtime. Based on market data, this position grade is 66 and has a 10% annual incentive target based on company, department, and individual performance goals. Salary determined at offer will be based on labor market data and a candidate's years of relevant work experience and skills relevant to the position.
CHPW offers the following benefits for Full and Part-time employees and their dependents:
- Medical, Prescription, Dental, and Vision
- Telehealth app
- Flexible Spending Accounts, Health Savings Accounts
- Basic Life AD&D, Short and Long-Term Disability
- Voluntary Life, Critical Care, and Long-Term Care Insurance
- 401(k) Retirement and generous employer match
- Employee Assistance Program and Mental Fitness app
- Financial Coaching, Identity Theft Protection
- Time off including PTO accrual starting at 17 days per year.
- 40 hours Community Service volunteer time
- 10 standard holidays, 2 floating holidays
- Compassion time off, jury duty pay.
Sensory/Physical/Mental Requirements:Sensory*:
- Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.
Physical*:
- Extended periods of sitting, computer use, talking and possibly standing.
- Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion.
- Frequent torso/back static position; occasional stooping, bending, and twisting.
- Some kneeling, pushing, pulling, lifting, and carrying (not over 25 pounds), twisting, and reaching.
Mental:
- Must have the ability to learn and prioritize multiple tasks within the scope and guidelines of the position and its applicable licensure requirements, many requiring extremely complex cognitive capabilities. Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.
Work Environment:Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.
*Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.
*The above is intended to describe the general content of and the requirements for satisfactory performance in this position. It is not to be construed as an exhaustive statement of the duties, responsibilities, or requirements of this position. Job descriptions may be updated or changed to reflect business needs.
