Open to opportunities

GRADY PEARSON

@gradypearson

Quality and accreditation leader improving patient safety through data-driven risk mitigation, process improvement, and team mentorship.

United States

Message

What I'm looking for

I’m looking for a leadership role where I can drive safety and quality through accreditation excellence, risk mitigation, and continuous process improvement—building high morale teams with open communication, mentorship, and measurable outcomes.

I lead teams to achieve best-in-class levels for safety and quality through teamwork, collaboration, and continuous process improvement to serve the needs of patients. I’m a creative problem solver who embraces diversity and thrives on complexity, and I focus on solutions while building a culture of open communication, collaboration, mentorship, and high morale.

Across senior leadership roles, I’ve driven URAC, NABP, and ACHC accreditation and learning/change management, with strong audit readiness and risk identification and mitigation. I improve outcomes using data analytics and root cause analysis—e.g., boosting clinical decision quality (65% to 92%), increasing inpatient accuracy (91% to 97%), and improving call quality monitoring efficiency by 25% with annual savings of $100K.

Experience

Work history, roles, and key accomplishments

Pharmacy Accreditation Reviewer

URAC

Jan 2023 - Jan 2024 (1 year)

Served as a technical expert on URAC accreditation program content and standards for Mail/Specialty pharmacies and PBM supporting commercial lines of business. Conducted desktop reviews and provided constructive written and verbal feedback while supporting client relationships and program guide and workshop/webinar development.

Desktop Auditing Risk Mitigation Program Guide And Webinar Development

Director, Concierge Service Ops

Oscare Health

Jan 2021 - Jan 2022 (1 year)

Led concierge call center operations for commercial health plans, reporting to the Service Operations Senior Director. Managed staffing for domestic and international operations (1000+ associates), grievances and resolutions, and ensured regulatory and contractual requirements were met.

Call Center Operations Staffing Budget Management Domestic International Operations Grievance Resolution Process Improvement

Associate VP, Learning & Accreditation

Humana, Inc.

Jan 2020 - Jan 2021 (1 year)

Led learning and accreditation efforts across Clinical Operations, Clinical Pharmacy, and Home Solutions, including change management and enterprise communications supporting the ECOM rollout to 5K+ associates. Improved clinical decision quality from 65% to 92% through MCG training and increased inpatient accuracy from 91% to 97% using data-driven targeted education.

Learning And Accreditation Change Management Enterprise Rollout (ECOM)

Associate VP, Quality & Accreditation

Humana, Inc.

Jan 2018 - Jan 2020 (2 years)

Directed quality, facilitation, and accreditation efforts across Healthcare Services lines of business, managing 7 direct reports and a 12K-associate organization. Improved home operation quality accuracy from 82% to 98%, increased clinical decision accuracy to 99%, reduced HCPR adverse reconsideration decisions by 78%, and decreased clinical service reships by 40% with $2.9M in 3-year savings.

Disease Specific Best Practices Accreditation Program Management

Director, Quality, Policy & Learning

Humana, Inc.

Jan 2013 - Jan 2018 (5 years)

Directed process, policy, learning, and quality teams, overseeing PBM, Mail, and Specialty quality management programs and call monitoring activities. Implemented a Quality Event process, reduced defects (DPMO) by 86% for Traditional Mail and 33% for Specialty, and delivered cost reductions of more than $2M through automation and audit tools.

Quality Management Quality Event Process Disaster Recovery Planning

Manager, Quality & Accreditation

Humana Pharmacy Solutions

Jan 2012 - Jan 2013 (1 year)

Identified and led quality improvement projects to enhance member safety and experience for Humana Pharmacy mail and specialty pharmacies. Managed audit and accreditation-related prioritization, established associate governance, and built performance management governance using audit data and KPIs.

Quality Improvement KPIs Associate Governance

Director, Quality & Accreditation

CVS Caremark

Jan 2004 - Jan 2012 (8 years)

Developed and managed a comprehensive PBM quality program in collaboration with medical and senior leadership via the Pharmacy Services Performance Improvement Council. Oversaw accreditation-related submissions and ensured compliance to accrediting and certification standards while managing quality program documentation revisions and accreditation cost planning.

Compliance Management Clinical Affairs Performance Improvement URAC NCQA VIPPS VAWD JCAHO Program Support

Education

Degrees, certifications, and relevant coursework

McWhorter School of Pharmacy, Samford University

Doctor of Pharmacy (PharmD), Pharmacy

Earned a Doctor of Pharmacy (PharmD) from the McWhorter School of Pharmacy at Samford University.

Northern Arizona University

Master’s Certificate, Professional Writing

Completed a Master’s Certificate in Professional Writing at Northern Arizona University.

University of Alabama at Birmingham

Bachelor of Science (BS), Natural Sciences and Mathematics

Grade: cum laude

Earned a Bachelor of Science (BS) in Natural Sciences and Mathematics with concentrations in biochemistry and molecular biology, with honors in biological research.