VP Quality and Accreditation

Florida Blue (Blue Cross and Blue Shield of Florida) • United States,

3d

About The Position

The Vice President, Quality & Accreditation is the enterprise executive accountable for clinical quality performance across Medicare and Commercial lines of business. The role owns HEDIS strategy and operations, accreditation (including NCQA, URAC, and applicable state and federal standards), clinical quality programs, and the vendor ecosystem supporting HEDIS data collection, abstraction, and reporting.

The executive unifies quality functions historically siloed by line of business into a single operating model, establishing consistent measurement, documentation, and improvement practices across populations. The role is accountable for HEDIS rates and audit results, accreditation status and survey outcomes, clinical quality program performance, and vendor ecosystem governance and cost.

The position leads enterprise quality governance and operations, clinical quality initiatives, accreditation strategy and survey readiness, HEDIS vendor governance, quality analytics and reporting, and regulatory compliance. It works with internal leaders and Health Services Analytics to coordinate enterprise-wide quality priorities and reporting.

Requirements

• 10+ years of leadership experience in health plan Quality, HEDIS, and Accreditation across Medicare and Commercial lines of business.
• Proven track record of improving HEDIS rates and achieving strong NCQA/URAC accreditation outcomes.
• Deep knowledge of HEDIS technical 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.

Nice To Haves

• Bachelor's degree in healthcare administration, public health, business, or a related field preferred.
• Master's degree in healthcare administration, public health, business, or a related field preferred.

Responsibilities

• Build a unified quality operating model across Medicare and Commercial lines of business.
• Establish enterprise governance for clinical documentation integrity supporting quality measurement.
• Serve as executive owner of enterprise HEDIS performance and accreditation status.
• Oversee HEDIS operations, hybrid strategy, supplemental data, and provider documentation improvement across Medicare and Commercial lines of business.
• Develop intervention playbooks for each HEDIS measure.
• Lead enterprise clinical quality programs, including quality improvement initiatives, clinical practice guideline adoption, and provider quality performance programs.
• Align 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 across the enterprise without taking accountability for their respective programs.
• Own enterprise accreditation strategy and execution, including NCQA Health Plan Accreditation, URAC, and applicable state and federal accreditation or certification requirements.
• Lead survey readiness, documentation, and corrective action planning for accreditation activities.
• Maintain accreditation standards as they evolve and ensure readiness for renewal cycles.
• Own the vendor ecosystem supporting HEDIS data collection, medical record retrieval, abstraction, and supplemental data.
• Consolidate and manage HEDIS vendors to reduce cost, improve data quality, and strengthen audit defensibility.
• Establish unified SLAs, KPIs, and performance governance for HEDIS-related vendors.
• Ensure vendors operate as extensions of the internal quality team.
• Ensure data quality, timeliness, and integration across clinical, operational, and vendor systems supporting quality measurement.
• Partner with Health Services Analytics to build a unified reporting architecture for HEDIS, accreditation, and clinical quality programs.
• Ensure compliance with NCQA, URAC, and applicable regulatory requirements governing quality and accreditation.
• Lead enterprise audit readiness for HEDIS and accreditation surveys.
• Establish governance structures for decision-making, escalation, and cross-functional alignment on quality matters.

Benefits

• Medical, dental, vision, life, and global travel health insurance.
• Life insurance and short- and long-term disability programs.
• Leave programs to support personal circumstances.
• Retirement Savings Plan including employer match.
• Paid time off, volunteer time off, 10 holidays, and 2 well-being days.
• Additional voluntary benefits.
• Comprehensive wellness program.
• Competitive pay and opportunities for incentive or commission compensation.
• Regular annual reviews with pay-for-performance considerations for base pay increases.

What This Job Offers

• Job Type: Full-time
• Career Level: Executive
• Education Level: No Education Listed