Tufts Health Plan – Manager, Quality and Accreditation Programs

Under the supervision of the Director, Quality, Accreditation and Regulatory Compliance Programs, the Manager of Quality and Accreditation Programs is responsible to manage the enterprise-wide development, modification, implementation and coordination of systems and processes necessary to meet all NCQA accreditation and certification requirements. The Manager of Quality and Accreditation Programs facilitates cross-departmental and enterprise-wide meetings, processes and programs with more senior internal and external business partners. The Manager works as needed with outside organizations (i.e, AHIP, ACHP, NCQA) on accreditation related issues, such as: scheduling surveys, attending tele-conferences, advocating for standard changes and providing feedback on proposed standard changes for new and existing accreditation programs.


1. Manages enterprise-wide NCQA accreditation and certification processes

  • Assesses compliance with current and new NCQA standards on an ongoing basis.
  • Identifies gaps and risks; providing regular status reports to appropriate management and senior management and developing strategies to mitigate risks and gaps considering business needs and compliance requirements.
  • Acts as the primary contact and resource for NCQA accreditation/certification and standard interpretation throughout the enterprise.
  • Responsible for the development and management of systems and processes to meet NCQA requirements.
  • Manages and oversees enterprise wide preparation for NCQA site visits, including completing applications, preparatory audits, mock reviews and documentation.
  • Oversees the development, implementation and adherence to uniform reporting standards; responsible for high-level analysis of department and defined corporate metrics to validate business and program effectiveness.
  • Supervises the CQI program managers and staff who assist standard owners and project teams in the development and coordination of project initiatives required to meet accreditation requirements.
  • Responsible for NCQA standards.
  • Serves as the primary contact, within the Healthcare Services division, for RFP responses related to NCQA accreditation questions.
  • Reviews and refines documentation for NCQA surveys.

2. Supervises and Manages Quality and Accreditation staff 

  • Provides mentorship, supervision and training to ensure each is working at his/her potential, is encouraged to develop professionally, fosters cross training and supports adequate depth of skill mastery.
  • Develops a plan for training and developing members to grow into more senior roles.
  • Trains and assists with education efforts for new and existing Tufts Health Plan regarding accreditation policies and requirements.

3. Manages the annual development, evaluations and updates of QI Program Documentation for all Tufts Health Plan products.

  • Provides support to CQI, managers and other project leaders in the development, implementation and analysis of projects and initiatives.
  • Works closely with appropriate departments and at times, network providers and outside organizations, in the development and implementation of comprehensive project plans that will meet accreditation and regulatory standards.
  • Functions as a leader, facilitator or member of QI workgroups and project teams.
  • Develops, prioritizes, and manages the programmatic and policy components of the Clinical Quality Improvement projects and/or initiatives as they relate to QI compliance, accreditation and QI projects and initiatives.

4. Participates in the evaluations of new and existing NCQA Accreditations and Certifications; assessing how geographic expansion or new products will impact existing NCQA Accreditations and Certifications. Supports work to assess new and evaluate existing NCQA accreditation and certification processes

Knowledge requirements (education & experience):
* Bachelors Degree required.
* Masters or Advanced degree d in related industry and/or equivalent work experience in field related to Accreditation/Compliance or Regulatory responsibilities highly preferred
* 8+ years of program management experience including leading the most cross-functional high level initiatives
* 10 or more years’ business or industry experience
* Experience supervising or managing a team

Skill requirements (include complexity of position):
* Highly developed verbal and written skills, and ability to facilitate planning and review sessions with senior Tufts Health Plan management
* Must have excellent organizational skills and be able to effectively manage multiple priorities
* Requires attention to detail to accomplish both small critical tasks of projects along with having a thorough understanding of the project’s impact on other departments, as well as implications for the company and provider network
* Highest level of presentation skills including ability to interface and “sell” new programs and changes to existing programs to a broad range of internal and external contacts, while effectively managing difficult group dynamics to effectively reach a positive outcome
* Proactively identifies conflict/integration issues, and leads team members to parse/synthesize issues of the highest complexity. Able to identify risk out of the larger picture and has a proven ability to accurately estimate and plan resource usage. Able to identify and make decisions that serve the best interests of Tufts Health Plan. Must be effective in conceptualizing and envisioning the impact of change and garnering support for new ways to do business.
* Advanced training in the field related to the program is preferred
* Demonstrates self-direction, possess a high level of motivation and political astuteness, outstanding interpersonal, teaching, decision making, written/oral communication skills

Interpersonal skills (include personal interaction):
* Able to resolve most roadblocks to program progress using knowledge of the company.
* Able to instruct others in Program Management techniques and operate in a matrixed environment.
* Must be able to work both independently and as part of a team.

Confidential data:
All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Will be exposed to and required to deal with highly confidential and sensitive material. Must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.

Working Conditions or Additional requirements (include special requirements, e.g., lifting, travel, overtime)
* Fast paced office environment handing multiple demands
* Must be able to exercise appropriate judgment as necessary
* Use of telephone and PC required
* May require occasional evening or weekend hours as projects dictate
* May require occasional vendor visits overnight

*Essential functions occur simultaneously, therefore, the employee must be able to appropriately handle each essential function, prioritize them and seek assistance when necessary. These functions need to be performed on a consistent and regular basis, using good judgment. Ability to learn and apply company policies consistently, seeking out guidance when necessary, is required.


To apply please use the following link:  https://recruiting.adp.com/srccar/RTI.home?c=1058241&d=External&r=5000077754706