Accreditation Director

The Elevance Health Companies of Puerto Rico, LLC; San Juan (PR); Hybrid; USD 90,000 - 130,000; Full time

Benefits offered by this job

Merit increases

Paid holidays

Paid Time Off

Medical benefits

Dental benefits

Vision benefits

401(k) + match

Stock purchase plan

Job summary

Carelon Global Solutions (CGS) in Puerto Rico seeks an Accreditation Director to lead quality and accreditation initiatives, overseeing processes and coordinating with internal teams and external bodies.

The role requires a BA/BS in a healthcare field with 3+ years healthcare experience and 5+ years in QA/QI, plus bilingual English/Spanish. NCQA/URAC accreditation experience is highly preferred. Hybrid work in San Juan.

Qualifications

• BA/BS in a healthcare field.
• Minimum 3 years healthcare-related experience.
• Minimum 5 years in QA/QI roles.
• Equivalent education/experience accepted.

Responsibilities

• Oversee accreditation processes and resources.
• Review quality improvement data and implement interventions.
• Interpret accreditation guidelines and manage activities.
• Identify resources and accountabilities for project teams.
• Conduct evaluation of quality standards to ensure compliance.
• Serve as expert resource to quality committees and business owners.
• Lead and oversee accreditation work plans with clear deliverables.
• Perform data analysis and report improvements to the quality committee.

Skills

Bilingual English/Spanish

QA/QI leadership

Healthcare industry experience

Education

BA/BS in healthcare

Job description

Anticipated End Date: 2026-10-23

Position Title:

Accreditation Director

Location:

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

Hybrid:

Hybrid 2: 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. 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.

About the Company:

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.

Primary Duties:

• 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.

Job Level:

Director

Job Family:

QLT > Clinical Quality

Benefits:

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.

Equal Employment Opportunity Statement:

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.

Accommodation:

Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.

Additional Information:

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.