VP Quality and Accreditation

GuideWell Source

. Build a unified quality operating model across all lines of business, including Medicare and Commercial .

Posted 10/19/2026full-timeRemote • United StatesLeadWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive expertise in HEDIS performance improvement, accreditation strategies, and clinical quality program leadership. Proven ability to manage complex vendor ecosystems and ensure compliance with NCQA and URAC standards.

Highest-signal resume keywords

HEDIS Performance ImprovementNCQA AccreditationClinical Quality Program LeadershipVendor ManagementFinancial Acumen

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

HEDIS Technical SpecificationsClinical Quality Improvement MethodologyData Quality ManagementAccreditation Standards ComplianceForecastingROI AnalysisBudget Management

Soft Skills

Influencing Senior ExecutivesDriving Enterprise-Wide ChangeCross-Functional Team Leadership

Tools & Technologies

Health Services AnalyticsQuality Measurement Systems

Industry Keywords

MedicareCommercial Health PlansClinical Documentation IntegrityQuality Improvement InitiativesAccreditation Readiness

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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