Director Clinical Quality Accreditation

Anticipated End Date:

2025-05-21

Position Title:

Director Clinical Quality Accreditation

Job Description:

Director Clinical Quality Accreditation (Dir Clinical Quality)

Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered.

The Director Clinical Quality Accreditation is responsible for working with the Clinical and Quality leads to direct the clinical quality initiatives, including NCQA accreditation and compliance with regulatory agencies and other objectives.

How you will make an impact:

• Works with both internal and external customers to promote understanding of health services activities and objectives within the company and to prioritize departmental projects, including maintaining NCQA, URAC and other accreditation compliance, according to Carelon corporate, regional, and departmental goals.
• Maintains expert knowledge of current industry standards, accreditation standards, quality improvement activities, and strong medical management skills.
• Manages the overall accreditation processes and resources to successfully lead the team.
• Assures the training and continuing education of staff regarding standards and guidelines, including NCQA and HEDIS.
• Hires, trains, coaches, counsels, and evaluates the performance of direct reports.

Minimum Requirements:

Requires BA/BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences) and 5 years progressively responsible management experience in a health care environment or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• Current unrestricted license, certification in applicable field (i.e. CPHQ), MS or advanced degree in a health care related field (i.e. nursing, health education) or business strongly preferred.
• Previous experience working with accrediting bodies like NCQA, URAC, AAS, or ICH and HEDIS preferred.
• Successful NCQA/URAC accreditation process completion and continuous process improvement experience in an NCQA/URAC setting strongly preferred.
• Experience working in the managed care/healthcare insurance industry most notably in accreditation strongly preferred.
• Exceptional strategic thinking, decision-making, problem-solving skills, and adaptability highly preferred.
• Experience interacting confidently with senior management and executive level stakeholders, as a subject matter expert and comfortable with influencing decision-making preferred.
• Excellent written, oral, presentation and interpersonal communication skills with the proven ability to negotiate expectations between multiple parties strongly preferred.
• Proficient of Microsoft Office products Excel, Teams, Outlook, PowerPoint, Word and Power BI strongly preferred.

Job Level:

Director

Workshift:

1st Shift (United States of America)

Job Family:

QLT > Clinical Quality

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ... for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.