Remote Quality & Compliance Leader—Health Plan Accreditation

Wns; Houston (TX); Remote; USD 100,000 - 125,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

PTO, holidays, and sick leave

401(k) with company match

Life and AD&D Insurance

Employee Assistance Program

Job summary

WNS, part of Capgemini, is an Agentic AI-powered leader in intelligent operations and transformation, serving more than 700 clients across industries. This role leads the Quality Management Program, compliance activities, and accreditation readiness within a HIPAA-compliant remote environment in the United States.

The candidate will drive KPI reporting, root-cause analyses, and corrective actions while partnering with operations, clinical leadership, and compliance to ensure sustained quality

Qualifications

• Graduate of an accredited nursing program with active RN license.
• 5+ years of utilization management experience in a health plan, UM vendor, or delegated UM organization.
• 3+ years of quality, audit, compliance, accreditation, or quality management experience.
• 2+ years of progressive leadership in a managed care environment with staff oversight.
• CPHQ preferred; Lean Six Sigma or other process improvement training is a plus.
• Knowledge of URAC and/or NCQA accreditation standards and quality program requirements.

Responsibilities

• Leads the Quality Management Program, including annual evaluation, quality improvement initiatives, KPI development, and performance monitoring.
• Identifies risks; conducts root cause analyses; develops corrective action plans and monitors interventions.
• Develops and oversees quality audit programs for clinical activities and data integrity audits.
• Maintains readiness for accreditation surveys, client audits, and regulatory reviews by updating policies and evidence repositories.
• Leads Quality Management and Compliance Committees and provides governance and reporting to leadership.
• Oversees regulatory and accreditation education tracking, credentialing, and related activities.

Skills

Leadership

Quality management

KPI reporting

Root cause analysis

Communication

Education

RN license

BSN preferred

MSN preferred

CPHQ certification preferred

Lean Six Sigma training

Job description

WNS, part of Capgemini, is an Agentic AI-powered leader in intelligent operations and transformation, serving more than 700 clients across industries. This role leads the Quality Management Program, compliance activities, and accreditation readiness within a HIPAA-compliant remote environment in the United States.

The candidate will drive KPI reporting, root-cause analyses, and corrective actions while partnering with operations, clinical leadership, and compliance to ensure sustained quality