Dir Quality & Accreditation
About the position
At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve. Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there's no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you'll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community. The ideal candidate will live within driving distance of the Omaha, Nebraska office. This position allows remote flexibility but will have 2-3 days per week in the office. Provides strategic leadership for enterprise-wide clinical quality performance, improvement, and accreditation standards. Partners with senior leaders and operational teams to ensure regulatory alignment, mitigate risk, and drive continuous improvement in compliance practices.
Responsibilities
• Lead strategic direction for quality programs impacting Medicare, Medicaid, ACA, and Commercial lines of business.
• Develop and execute an enterprise quality roadmap integrating measurement, analytics, reporting, and intervention strategies.
• Serve as primary liaison with external accreditation bodies (e.g., NCQA, URAC, Joint Commission).
• Oversee all accreditation activities, including site visits, audits, and reporting.
• Lead Quality Improvement Program (QIP) and Quality Assurance and Process Improvement (QAPI) initiatives.
• Guide creation and interpretation of policies and procedures related to quality of care, improvement, and accreditation.
• Partner with internal stakeholders and committees to ensure excellent performance on clinical quality measures.
• Leverage data and analytics to forecast performance, monitor progress, and identify risks and opportunities for improvement.
Requirements
• Bachelor's degree in Healthcare, Business Administration, Nursing, or related field.
• 10 years of progressive experience in healthcare quality program management, quality improvement, HEDIS operations, and accreditation.
• Proven leadership in managing enterprise compliance programs and accreditation processes.
• Strong understanding of federal/state regulations and accreditation standards.
• Experience with project management and Agile methodologies.
• Exceptional communication, analytical, and stakeholder engagement skills.
• An equivalent combination of education and experience may be substituted for this requirement.
• The ability to meet or exceed the attendance and timeliness requirements of their departments.
• The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
• The requirements listed are representative of the knowledge, skill, and or ability required.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Other duties may be assigned.
Nice-to-haves
• Master's degree in a related field.
• Healthcare Quality certification (e.g., CPHQ).
• Experience with patient safety initiatives and risk management practices.
• Familiarity with electronic health records (EHR) systems and value-based care.
• Demonstrated commitment to DEI and reducing health disparities.
• Ability to motivate and lead teams through change and process improvement.
Apply Now
Apply Now
At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve. Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there's no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you'll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community. The ideal candidate will live within driving distance of the Omaha, Nebraska office. This position allows remote flexibility but will have 2-3 days per week in the office. Provides strategic leadership for enterprise-wide clinical quality performance, improvement, and accreditation standards. Partners with senior leaders and operational teams to ensure regulatory alignment, mitigate risk, and drive continuous improvement in compliance practices.
Responsibilities
• Lead strategic direction for quality programs impacting Medicare, Medicaid, ACA, and Commercial lines of business.
• Develop and execute an enterprise quality roadmap integrating measurement, analytics, reporting, and intervention strategies.
• Serve as primary liaison with external accreditation bodies (e.g., NCQA, URAC, Joint Commission).
• Oversee all accreditation activities, including site visits, audits, and reporting.
• Lead Quality Improvement Program (QIP) and Quality Assurance and Process Improvement (QAPI) initiatives.
• Guide creation and interpretation of policies and procedures related to quality of care, improvement, and accreditation.
• Partner with internal stakeholders and committees to ensure excellent performance on clinical quality measures.
• Leverage data and analytics to forecast performance, monitor progress, and identify risks and opportunities for improvement.
Requirements
• Bachelor's degree in Healthcare, Business Administration, Nursing, or related field.
• 10 years of progressive experience in healthcare quality program management, quality improvement, HEDIS operations, and accreditation.
• Proven leadership in managing enterprise compliance programs and accreditation processes.
• Strong understanding of federal/state regulations and accreditation standards.
• Experience with project management and Agile methodologies.
• Exceptional communication, analytical, and stakeholder engagement skills.
• An equivalent combination of education and experience may be substituted for this requirement.
• The ability to meet or exceed the attendance and timeliness requirements of their departments.
• The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
• The requirements listed are representative of the knowledge, skill, and or ability required.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Other duties may be assigned.
Nice-to-haves
• Master's degree in a related field.
• Healthcare Quality certification (e.g., CPHQ).
• Experience with patient safety initiatives and risk management practices.
• Familiarity with electronic health records (EHR) systems and value-based care.
• Demonstrated commitment to DEI and reducing health disparities.
• Ability to motivate and lead teams through change and process improvement.
Apply Now
Apply Now