Director of Quality and Compliance – Healthcare

This is a fully remote position, open to applicants in United States.

📋 Description

• Take ownership of all Standard Operating Procedures (SOPs), state and health plan addenda, annual reviews, updates, and document control.

• Define compliance requirements, regulatory or contractual sources, and acceptance criteria for platform controls.

• Receive, triage, review, and manage incidents, accidents, deaths, and suspected abuse, neglect, or exploitation.

• Determine reportability and file external reports within the applicable deadlines.

• Track follow-up reports, returned reports, confirmations, and closure.

• Escalate sentinel events and deaths to the Medical Director and CEO.

• Maintain incident rules tables and abuse hotline directories with approved change control.

• Ensure that mandated reporter obligations are met and documented.

• Lead root cause analyses and develop corrective and preventive action plans.

• Present corrective actions to the HEQMC and monitor verified completion.

• Plan and conduct internal audits of clinical, billing, CoCM, RTM, consent, and telehealth documentation.

• Report audit findings, root causes, and corrective actions; track closure and re-audit processes.

• Coordinate findings from pre-bill reviews and overpayment refunds with the revenue cycle team.

• Collaborate on SOP training, competency checks, staff briefings, and maintenance of training records.

• Coordinate technology dependencies and interim operational controls with Product Development.

• Prepare responses to payer quality-of-care inquiries, audits, record requests, and corrective action requests.

• Monitor changes in state Medicaid, health plans, CMS, privacy regulations, and contracts.

• Maintain accounts for state and health plan reporting portals.

• Serve as the HEQMC secretariat, preparing agendas, minutes, action logs, SOP approvals, and quarterly quality packs.

• Report quality and compliance metrics to the HEQMC and CEO.

• Support NCQA Health Equity Accreditation readiness and accreditation efforts.

⛳️ Requirements

• Clinical license (such as RN, LCSW, LPC); or a bachelor’s degree in a health-related field; or a bachelor’s degree in business, operations management, industrial engineering, or a related field; or equivalent formal training in operations management, process improvement, or quality management.

• 7+ years of experience in healthcare quality, compliance, risk management, accreditation, operations management, or process improvement and quality management.

• Experience with multistate compliance.

• Familiarity with regulatory reporting and compliance.

• Experience in incident or event management, root cause analyses, and development of corrective action plans.

• Proven experience in writing and maintaining SOPs and training staff effectively.

• Strong writing skills are essential.

• Working knowledge of HIPAA Privacy and Security Rules and 42 CFR Part 2.

• Comfortable working with EHR or app-based workflows, dashboards, and spreadsheets.

• Experience in healthcare quality, compliance, risk management, accreditation, operations management, or process improvement.

• Bonus qualifications: CHC, CPHQ, Lean Six Sigma Green Belt or higher, ASQ CQIA/CQE, experience with mandated reporter duties, telehealth, behavioral health, integrated primary care, Collaborative Care, state Medicaid, NCQA accreditation, CoCM/RTM documentation and billing, health equity data stratification, or a master’s degree.

🏝️ Benefits

• Annual leadership bonus.

• Unlimited Paid Time Off (PTO).

• Flexible work schedules.

• Remote-first company culture.

• Comprehensive health, dental, vision, life, and disability benefits.

• 401(k) plan with company matching.

• Opportunities for self-care.

• Potential for growth within a high-impact, mission-driven startup.

• Equal opportunity employer.