Chief Quality & Accreditation Officer

GuideWell; United States; On-site; USD 250,000 - 350,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

Retirement plan with employer match

Paid time off and holidays

Wellness program

Job summary

GuideWell is seeking a Vice President of Quality & Accreditation to unify quality across Medicare and Commercial lines and lead HEDIS strategy, accreditation, and related vendor governance.

The role drives enterprise quality programs, analytics, and reporting, partnering with senior leaders to align care management, population health, and operations while ensuring regulatory readiness and cost efficiency.

Qualifications

• 10+ years of leadership in health plan Quality, HEDIS, and Accreditation across Medicare and Commercial lines.
• Bachelor's degree in healthcare administration, public health, business, or related field preferred.
• Proven track record of improving HEDIS rates and accreditation outcomes.
• Deep knowledge of HEDIS 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.

Responsibilities

• 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.
• Lead enterprise clinical quality programs, including quality improvement initiatives 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 coordinate quality initiatives enterprise-wide.
• Own enterprise accreditation strategy and execution, including NCQA Health Plan Accreditation, URAC, and other applicable requirements.
• Lead survey readiness, documentation, and corrective action planning for all accreditation activities.
• Maintain accreditation standards as they evolve and ensure readiness for renewal cycles.
• Serve as executive owner of the vendor ecosystem supporting HEDIS data collection, abstraction, and data delivery.
• Consolidate and manage HEDIS vendors to reduce cost, improve data quality, and strengthen audit defensibility.
• Establish unified SLAs, KPIs, and governance for HEDIS-related vendors.
• Ensure vendors operate as extensions of the internal quality team.
• Ensure data quality and timely reporting for quality measurement across clinical, operational, and vendor systems.

Skills

Leadership experience

HEDIS expertise

Accreditation

Vendor management

Financial acumen

Executive influence

Cross-functional leadership

Education

Bachelor's degree

Master's degree preferred

Job description

GuideWell is seeking a Vice President of Quality & Accreditation to unify quality across Medicare and Commercial lines and lead HEDIS strategy, accreditation, and related vendor governance.

The role drives enterprise quality programs, analytics, and reporting, partnering with senior leaders to align care management, population health, and operations while ensuring regulatory readiness and cost efficiency.