Quality & Accreditation Director

POSITION OVERVIEW

Harbor Health is seeking a seasoned, detail-oriented Quality & Accreditation Director to lead the implementation, refinement, and oversight of a comprehensive enterprise-wide Quality Management Program supporting our Texas fully insured Individual & Family Plan (IFP/Marketplace) and large group (25+ employees) commercial products. Harbor Health holds NCQA Health Plan Accreditation at Interim status, and this leader will guide the organization through the full (First) survey and sustain accreditation through renewal.

This role will serve as our internal NCQA expert, coordinating cross-functional efforts to put NCQA-reviewed policies into practice, build the implementation evidence and performance results required for a full survey, and maintain continuous survey readiness for our health plan and applicable NCQA programs for our medical group while driving performance improvement initiatives and maintaining regulatory compliance with Texas Department of Insurance (TDI), CMS Marketplace/QHP, and other applicable requirements.

Reporting to the Senior Director of Compliance, this position is critical to establishing Harbor Health's foundation for quality excellence as we scale our payvider model — and is central to our mission of transforming healthcare through an integrated approach to care delivery and coverage.

• Lead all aspects of NCQA accreditation continuation, including progression from Interim status through the First survey and subsequent renewal surveys, for IFP/Marketplace and large group commercial product lines.
• Own the integrated roadmap and timeline from Interim status to the First survey, including survey application and submission dates, look-back requirements, and owner accountability by standard and element.
• Implement and refine the policies and procedures reviewed at the Interim stage, translating them into operational workflows, and revising them based on implementation gaps, NCQA feedback, and standards changes.
• Ensure documentation of implementation is produced and retained as work occurs, including committee minutes, program documentation, reports, and file review samples, so that evidence is complete within NCQA look-back periods.
• Ensure NCQA status and timelines satisfy QHP accreditation requirements for continued Marketplace participation.
• Interpret and apply NCQA standards across the organization, developing and maintaining comprehensive compliance documentation and tracking tools (including file review preparation, evidence repositories, and mock surveys).
• Oversee all submission processes and ensure organizational readiness for reviews (including survey tool submission, file reviews, and responses to NCQA preliminary reports and follow-up requests).
• Conduct gap analyses, establish detailed project plans, and serve as the primary liaison for NCQA and regulatory audits (NCQA, TDI, and CMS).
• Maintain accreditation timelines and monitor overall accreditation status across the enterprise.
• Monitor NCQA standards updates and annual program changes, and translate them into policy, process, and workflow changes.
• Evaluate and plan for NCQA recognition or accreditation programs relevant to our medical group and care model (e.g., Patient-Centered Medical Home, credentialing, health equity, population health).

• Manage, implement, and continuously refine Harbor Health's enterprise-wide Quality Management Program (QMP), ensuring alignment with Texas and federal regulations (including TDI quality improvement requirements and the ACA Quality Improvement Strategy (QIS) for Marketplace plans) and NCQA standards.
• Manage the Policy and Procedure Library,…