Accreditation Director

Elevance Health•San Juan, PR

8d•Hybrid

About The Position

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. 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.

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.

Nice To Haves

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.

Responsibilities

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.