Corporate Director of Accreditation and Compliance

Amerihealth Caritas•,

5d•Remote

About The Position

The Corporate Director of Accreditation and Compliance provides strategic and operational leadership for accreditation readiness, regulatory compliance, quality governance, and continuous improvement across the organization. This role ensures federal, state, contractual, and accrediting body requirements are effectively interpreted, operationalized, monitored, and sustained through strong governance, audit and survey readiness, corrective action planning, documentation integrity, and cross-functional partnership. Serving as a senior subject matter expert and advisor to executive leadership and business partners, the Corporate Director identifies and mitigates risk, drives accountability, supports quality and member/patient safety outcomes, and maintains a culture of continuous readiness across the enterprise or assigned line of business. This position oversees NCQA Health Plan Accreditation, Health Outcomes Accreditation, and supports other programs such as LTSS and PCMH programs as well.

Requirements

Bachelor’s Degree: Healthcare Administration, Nursing, Public Health, Business Administration, Health Informatics, Social Work, or a related field required.
Master’s Degree: Healthcare Administration, Public Health, Nursing, Business Administration, Health Policy, or a related discipline strongly preferred.
Minimum of 5 years of progressive healthcare, managed care, quality improvement, accreditation, compliance, regulatory oversight, audit readiness, clinical operations, or related experience required.
Minimum of 5 years of NCQA accreditation experience
Deep understanding of healthcare accreditation and regulatory requirements, including CMS, NCQA, Medicaid, Medicare, Exchange/Commercial, HIPAA, fraud, waste and abuse, privacy, contractual obligations, corrective action processes, quality improvement methodologies, and audit readiness practices.
Prior leadership experience overseeing teams, managers, enterprise programs, or complex cross-functional initiatives is strongly preferred.
Required prior experience driving and leading large-scale projects and cross-functional teams.
Demonstrated ability to lead through complexity, ambiguity, regulatory change, and organizational transformation.
Strong executive presence, business acumen, decision-making, stakeholder management, collaboration, and ability to influence without direct authority
Strong analytical, research, writing, facilitation, and presentation skills, with the ability to synthesize complex regulatory information, identify risk, develop practical solutions, and communicate recommendations clearly to executive, operational, clinical, and cross-functional audiences.

Nice To Haves

Certification in healthcare quality, compliance, patient safety, project management, or related discipline preferred, such as CPHQ, CHC, CPPS, Lean Six Sigma, PMP, or equivalent credential
Clinical licensure, such as RN, LCSW, or other relevant professional credential preferred

Responsibilities

Lead enterprise or line-of-business preparation for accreditation surveys, regulatory audits, site visits, file reviews, and readiness assessments. Serve as a primary liaison with accrediting bodies, auditors, regulators, and internal leadership to ensure timely, complete, and accurate responses.
Interpret and operationalize federal, state, accreditation, contractual, privacy, and enterprise requirements. Oversee the development, review, implementation, and monitoring of policies, procedures, controls, and workflows that support compliance with healthcare regulations and organizational standards.
Establish accreditation and compliance governance frameworks, readiness calendars, documentation standards, committee routines, escalation pathways, and accountability structures to support sustained compliance and continuous readiness.
Identify compliance, quality, operational, documentation, and performance risks through audits, monitoring, gap assessments, data analysis, and stakeholder feedback. Lead root cause analysis, corrective action planning, remediation tracking, and executive escalation as appropriate.
Partner with Quality, Clinical Operations, Population Health, Provider Network, Analytics, and market teams to align accreditation requirements with quality improvement initiatives, performance measures, member experience, patient safety, care gap closure, and health outcomes.
Develop and oversee dashboards, reporting routines, documentation repositories, evidence libraries, performance metrics, and quality controls to monitor readiness, track outcomes, validate compliance, and provide actionable insights to senior leadership.
Communicate new and evolving accreditation and regulatory requirements to leaders, associates, clinicians, providers, vendors, and cross-functional partners. Develop education, tools, and guidance that promote accountability, transparency, and a culture of compliance.
Lead, coach, and develop managers, specialists, analysts, and/or matrixed partners responsible for accreditation and compliance activities. Set clear priorities, establish performance expectations, remove barriers, and foster a high-performing, collaborative team culture.
Advise senior leadership on accreditation readiness, regulatory risk, compliance trends, audit results, corrective action status, and strategic opportunities to strengthen organizational performance and reduce exposure to fines, sanctions, penalties, or reputational risk.