VP Quality and Accreditation

Job not on LinkedIn

🔥 13 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

👔 Vice President

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 17%

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GuideWell Source

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

GuideWell Source is a company within the GuideWell Family that focuses on accelerating innovative health solutions to market, transforming and reshaping the health industry. It specializes in healthcare delivery, providing new models and superior outcomes for patients. The company emphasizes consumerism in healthcare, engaging clients in meaningful ways. GuideWell Source offers healthcare insurance, protecting employers and consumers with coverage plans and services. The company also provides administrative and claims processing services for state and federal Medicare and Medicaid programs, establishing itself as a trusted business partner in the healthcare sector with a focus on operational excellence.

📋 Description

• Build a unified quality operating model across all lines of business, including Medicare and Commercial • Establish enterprise governance for clinical documentation integrity supporting quality measurement • Serve as the executive owner of enterprise HEDIS performance and accreditation status • Oversee HEDIS operations, hybrid strategy, supplemental data, and provider documentation improvement across Medicare and Commercial lines of business • Develop intervention playbooks for each HEDIS measure • Lead enterprise clinical quality programs, quality improvement initiatives, clinical practice guideline adoption, and provider quality performance programs • Align with care management and population health functions on shared clinical priorities • Partner with COO, CFO, Network, Pharmacy, Stars, Risk Adjustment, and Operations leadership on enterprise-wide quality initiatives • Own enterprise accreditation strategy and execution, including NCQA Health Plan Accreditation, URAC, and applicable state and federal requirements • Lead survey readiness, documentation, and corrective action planning for accreditation activities • Maintain accreditation standards and organizational readiness for renewal cycles • Own the HEDIS vendor ecosystem supporting data collection, medical record retrieval, abstraction, and supplemental data • Consolidate and manage HEDIS vendors to reduce cost, improve data quality, and strengthen audit defensibility • Establish SLAs, KPIs, and performance governance for HEDIS-related vendors • Ensure vendors operate as extensions of the internal quality team • Ensure data quality, timeliness, and integration across systems supporting quality measurement • Build unified reporting architecture for HEDIS, accreditation, and clinical quality programs with Health Services Analytics • Ensure compliance with NCQA, URAC, and applicable regulatory requirements • Lead enterprise audit readiness for HEDIS and accreditation surveys • Establish governance structures for decision-making, escalation, and cross-functional alignment on quality matters

🎯 Requirements

• 10+ years of leadership experience in health plan Quality, HEDIS, and Accreditation across Medicare and Commercial lines of business • Bachelor's degree in healthcare administration, public health, business, or related field preferred • Proven track record of improving HEDIS rates and achieving strong NCQA/URAC accreditation outcomes • Deep knowledge of HEDIS technical specifications, NCQA accreditation standards, and clinical quality improvement methodology • Experience leading large cross-functional teams and complex vendor ecosystems, particularly HEDIS data and abstraction vendors • Strong financial acumen, including forecasting, ROI analysis, and budget management • Demonstrated ability to influence senior executives and drive enterprise-wide change • Master's degree in healthcare administration, public health, business, or related field 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 support personal circumstances • Retirement Savings Plan including employer match • Paid time off • Volunteer time off • 10 holidays • 2 well-being days • Additional voluntary benefits • Comprehensive wellness program • Opportunities for incentive or commission compensation • Annual reviews with pay for performance considerations for base pay increases