Ncqa Jobs in Silver Spring, MD (NOW HIRING)

This position will focus on leading program development, working on developing and optimizing clinical programs to better the CKD and ESRD population, using evidence-based research and best practices. This position will also be responsible for overseeing and leading the clinical program workflows as well as the clinical operational workflows.

This role requires an on‑site schedule at our office in McLean, VA.

• Subsidized, personal healthcare coverage (medical, dental, vision)
• Flexible PTO
• Professional Development, CEU, and Tuition Reimbursement
• Curated Wellness Benefits supporting teammates physical and mental well‑being
• Community engagement opportunities
• And more!

• Develop the program roadmap and break down roadmap into tactical plan in conjunction with the product team
• Lead development of new clinical programs for CKD & ESRD population, including understanding existing workflow, defining program goals, KPIs, and assessments
• Assess, monitor, and optimize existing programs to achieve operational effectiveness, reduction in costs, and improvement in patient quality
• Oversee clinical and operational workflows, refining as needed
• Ensure the programs, workflows, and trainings align with requirements set forth by NCQA, Medicaid, SNP and other regulatory entities
• Ability to interface with Senior Level Executives during client meetings / presentations
• Lead client workflow meetings for seamless collaboration as needed
• Work closely with payer partners to gather requirements, identify cross-system impacts, perform analysis, and drive project management
• Responsible for program and clinical operations collateral, including patient education materials, clinical team training manuals, and workflow documentation
• Collaborate closely with product development to ensure that technology solution supports clinical strategy
• Responsible for coordinating clinical program materials and new programs / new initiatives
• Collaborate with data and technology teams for successful development of reports related to clinical programs and workflows
• Contributes to a strong culture of continuous development and rapid iteration
• Perform other duties as assigned

• Bachelor’s degree with 7-10 years of related experience
• Clinical licensure: RN, NP, RD or PharmD is required
• Experience working with clients and other external stakeholders
• Strong interpersonal and communication skills are required for cross-functional collaboration
• Utilizes strong organizational skills to execute against roadmap with timely deliverables and close collaboration with internal and external stakeholders
• Skilled at using all Microsoft applications including Visio, Word, Excel, PowerPoint and other web‑based applications
• Understands and complies with highest standards of confidentiality
• Consistent track record of successfully leading program development and project management
• Understanding of healthcare workflows for population health, value‑based care, and care management
• Understanding of MOC, SNP, Medicaid, NCQA, contract, and training requirements
• Understanding of business development process and needs
• Ability to document and analyze complex business requirements and processes
• Ability to create training content from program requirements and needs
• Ability to manage multiple, competing priorities with minimal oversight
• Ability to handle ambiguity and desire to work in a fast‑paced start‑up environment

• Master’s degree
• Strong analytical skills
• Acute attention to detail
• Ability to be both a strategic and tactical change agent in the renal space
• Self‑starter who will take initiative and be proactive when there are multiple priorities
• Strategic solution‑seeker who sees opportunities when others see barriers
• Experience working with vulnerable patient populations (ESRD, CHF, geriatrics, minorities, low income, uninsured, etc.)
• Strong interpersonal skills and ability to communicate effectively

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Somatus, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Further, the company takes affirmative action to ensure that applicants are employed, and employees are treated during employment without regard to any of these characteristics. Discrimination of any type will not be tolerated.