VP Quality and Accreditation

This is a fully remote position, open to applicants in United States.

📋 Description

• Develop a cohesive quality operating framework across all business units, encompassing Medicare and Commercial sectors.

• Implement enterprise governance to ensure clinical documentation integrity that supports quality measurement.

• Act as the principal executive responsible for overseeing enterprise HEDIS performance and accreditation status.

• Manage HEDIS operations, hybrid strategies, supplemental data, and enhancements in provider documentation for both Medicare and Commercial lines of business.

• Create intervention playbooks tailored for each HEDIS measure.

• Direct enterprise clinical quality programs, quality improvement initiatives, the adoption of clinical practice guidelines, and provider quality performance programs.

• Collaborate with care management and population health teams on shared clinical priorities.

• Partner with the COO, CFO, Network, Pharmacy, Stars, Risk Adjustment, and Operations leadership to advance enterprise-wide quality initiatives.

• Take ownership of the enterprise accreditation strategy and its execution, which includes NCQA Health Plan Accreditation, URAC, and relevant state and federal requirements.

• Lead preparation, documentation, and corrective action planning for accreditation activities.

• Maintain accreditation standards and ensure organizational readiness for renewal cycles.

• Oversee the HEDIS vendor ecosystem responsible for data collection, medical record retrieval, abstraction, and supplemental data.

• Streamline and manage HEDIS vendors to reduce costs, enhance data quality, and fortify audit defensibility.

• Define SLAs, KPIs, and performance governance for HEDIS-related vendors.

• Ensure that vendors function as extensions of the internal quality team.

• Guarantee data quality, timeliness, and integration across systems that support quality measurement.

• Establish a unified reporting architecture for HEDIS, accreditation, and clinical quality programs in collaboration with Health Services Analytics.

• Ensure compliance with NCQA, URAC, and relevant regulatory requirements.

• Lead the enterprise's audit readiness for HEDIS and accreditation surveys.

• Create governance structures for decision-making, escalation, and cross-functional alignment regarding quality issues.

⛳️ Requirements

• Over 10 years of leadership experience in health plan Quality, HEDIS, and Accreditation within Medicare and Commercial sectors.

• A Bachelor's degree in healthcare administration, public health, business, or a related field is preferred.

• A proven history of enhancing HEDIS rates and achieving excellent NCQA/URAC accreditation outcomes.

• Extensive knowledge of HEDIS technical specifications, NCQA accreditation standards, and clinical quality improvement methodologies.

• Experience in leading large cross-functional teams and managing complex vendor ecosystems, specifically for HEDIS data and abstraction vendors.

• Strong financial skills, including forecasting, ROI analysis, and budget management.

• Demonstrated capability to influence senior executives and enact enterprise-wide change.

• A Master's degree in healthcare administration, public health, business, or a related field is preferred.

🏝️ Benefits

• Medical, dental, vision, life, and global travel health insurance.

• Income protection benefits, including life insurance and short- and long-term disability programs.

• Leave programs to accommodate personal circumstances.

• Retirement Savings Plan with employer matching.

• Paid time off.

• Volunteer time off.

• 10 holidays.

• 2 well-being days.

• Additional voluntary benefits.

• Comprehensive wellness program.

• Opportunities for incentive or commission-based compensation.

• Annual reviews that consider pay-for-performance for base pay increases.