Accreditation Director

Elevance Health; San Juan (PR); Hybrid; USD 110,000 - 150,000; Full time

Job summary

Elevance Health is seeking an Accreditation Director to lead accreditation activities across a line of business, region, or enterprise. The role reports to CGS with a focus on URAC and NCQA standards, coordinating cross‑functional teams to ensure compliant processes and timely deliverables.

Ideal candidates bring bilingual English/Spanish proficiency, a strong background in QA/QI, and leadership experience.

Qualifications

• BA/BS in healthcare field required; 3+ years healthcare experience.
• Minimum 5 years in QA/QI role; equivalent education/experience appreciated.
• Bilingual English/Spanish proficiency preferred.

Responsibilities

• Interfaces with internal and external clients, quality committees, and departments to review quality improvement data and implement interventions.
• Manages the overall accreditation processes and resources required to lead the team.
• Evaluates, interprets and summarizes accreditation guidelines and manages the process for accreditation activities.
• Identifies resources and accountabilities for project teams involved with accreditation.
• Conducts ongoing evaluation and interpretation of quality standards to ensure compliance through reporting and measurement studies.

Skills

Bilingual English/Spanish

Leadership experience

Quality improvement

Accreditation knowledge

Education

BA/BS in healthcare

5+ years QA/QI experience

Job description

Accreditation Director

Location: 654 Munoz Rivera Ave. Suites 1500 & 1600, San Juan, Puerto Rico.

Hybrid 2: This role requires associates to be in-office3days 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.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Schedule: This position will work an 8-hour shifts between 8:00 am - 5:00 pm (AST), Monday through Friday. Additional hours, including weekends or holidays, may be required based on operational needs.

Carelon Global Solutions (CGS), a fully owned subsidiary of Elevance Health, is a healthcare solutions company that is simplifying complex operational processes to improve the health of the healthcare system.

Our Puerto Rico location operates a bilingual Spanish and English call center, providing clear and precise answers to customer queries.

The Accreditation Director is responsible for leading all accreditation activities for a line of business, region of the company, standards set, and/or enterprise wide which are necessary for attaining and maintaining accreditation from various accrediting organizations, such as URAC and NCQA.

How You Will Make an Impact

Primary duties may include, but are not limited to:

• Interfaces with internal and external clients, quality committees, and departments in the review of quality improvement data and in the implementation of appropriate interventions to effect improvement.
• Manages the overall accreditation processes and resources required to successfully lead the team.
• Evaluates, interprets and summarizes accreditation guidelines and manages the process for accreditation activities.
• Identifies appropriate resources and accountabilities for project teams involved with accreditation.
• Conducts the ongoing evaluation and interpretation of quality standards and accreditation standards to ensure compliance through reporting and measurement studies/ methodologies.
• Serves as expert resource to quality committees and business owners across the organization.
• Leads and provides oversight of quality studies/projects.
• Facilitates project management and oversees comprehensive accreditation work plans by establishing deliverables, accountabilities, and timelines for team members.
• Performs quantitative and qualitative analysis of quality related data and reports activities, improvements, and recommendations to the quality committee.

Minimum Requirements:

• Requires a BA/BS in a health care field and minimum of 3 years healthcare-related experience, in addition, minimum of 5 years experience in a QA/QI related position; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• Fully Bilingual (English & Spanish). Ability to write, read and speak both languages in a proficiency level is highly preferred.
• Successful NCQA/URAC accreditation process completion and continuous process improvement experience in an NCQA/URAC setting strongly preferred.
• Nursing background with case management and accreditation survey experience is highly preferred.
• Previous experience in a leadership role is preferred.
• Clinical healthcare experience strongly preferred.

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 should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.

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.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.