VP Quality and Accreditation

The Vice President, Quality & Accreditation is the enterprise executive accountable for clinical quality performance across all lines of business, including Medicare and Commercial. This role owns HEDIS strategy and operations, accreditation (NCQA, URAC, and applicable state/federal standards), clinical quality programs, and the vendor ecosystem that supports HEDIS data collection, abstraction, and reporting.

This executive unifies quality functions historically siloed by line of business into a single operating model, ensuring consistent measurement, documentation, and improvement practices across Medicare and Commercial populations.

The role is accountable for HEDIS rates and audit results, accreditation status and survey outcomes, clinical quality program performance, and vendor ecosystem governance and cost.

Key Responsibilities:
Enterprise Quality Leadership & Operating Model
• 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 all HEDIS operations, hybrid strategy, supplemental data, and provider documentation improvement, across Medicare and Commercial lines of business.
• Develop best-in-class intervention playbooks for each HEDIS measure.

Clinical Quality

• Lead enterprise clinical quality programs, including quality improvement initiatives, clinical practice guideline adoption, and provider quality performance programs.
  • Ensure alignment with care management and population health functions on shared clinical priorities.
  • Partner with COO, CFO, Network, Pharmacy, Stars, Risk Adjustment, and Operations leadership to ensure quality initiatives are coordinated enterprise-wide without assuming accountability for their respective programs.
  Accreditation
  • Own enterprise accreditation strategy and execution, including NCQA Health Plan Accreditation, URAC, and other applicable state and federal accreditation or certification requirements.
  • Lead survey readiness, documentation, and corrective action planning for all accreditation activities.
  • Maintain accreditation standards as they evolve and ensure organizational readiness for renewal cycles.
  HEDIS Vendor Ecosystem Leadership
  • Serve as the executive owner of the vendor ecosystem supporting HEDIS 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 unified SLAs, KPIs, and performance governance for HEDIS-related vendors.
  • Ensure vendors operate as extensions of the internal quality team.
  Quality Analytics, Reporting & Forecasting
  • Ensure data quality, timeliness, and integration across clinical, operational, and vendor systems supporting quality measurement.
  • In partnership with Health Services Analytics, build a unified reporting architecture for HEDIS, accreditation, and clinical quality programs.
  Governance & Compliance
  • Ensure compliance with NCQA, URAC, and applicable regulatory requirements governing quality and accreditation.
  • Lead enterprise audit readiness for HEDIS and accreditation surveys.
  • Establish governance structures for decision-making, escalation, and cross-functional alignment on quality matters.

Key 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.

General Physical Demands: Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

What We Offer:

As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance;
  • Income protection benefits: life insurance, 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 and 2 well-being days;
  • Additional voluntary benefits available; and

• A comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.

Originally posted on Himalayas