EAP Compliance and Quality Program Coordinator

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

📋 Description

• Oversee regulatory reporting, documentation, filing obligations, and compliance schedules related to the Knox-Keene license.

• Keep track of regulatory and legislative changes and convey their implications to leadership and stakeholders.

• Aid in audit preparedness by gathering documentation, preparing evidence, and following up on regulatory matters.

• Maintain thorough records of filings, inquiries, corrective actions, and commitments to regulatory standards.

• Identify compliance risks and propose actions or escalations as necessary.

• Supervise grievance processes from initiation to resolution, including tracking, documentation, investigation, and closure.

• Conduct inquiries and manage non-clinical grievance communications effectively.

• Draft compliant grievance correspondence and ensure proper case documentation is maintained.

• Examine grievance trends and suggest process enhancements, training opportunities, and corrective measures.

• Coordinate daily activities related to compliance, grievances, and quality programs.

• Manage workplans, dashboards, tracking tools, action-item logs, and regulatory calendars efficiently.

• Track deadlines, dependencies, and risks; escalate issues as necessary.

• Prepare materials and documentation for compliance and quality meetings.

• Provide updates to leadership on compliance activities, grievance trends, and quality initiatives.

• Serve as a liaison with clinical leadership, operations, legal counsel, Provider Relations, and other stakeholders.

• Enhance reporting processes, documentation standards, and workflow efficiency.

• Assist with training and education on compliance, audits, grievances, and reporting.

• Support accreditation and compliance efforts across various business areas.

• Evaluate compliance, grievance, and service data to uncover trends and opportunities for improvement.

• Facilitate root cause analysis and monitor corrective and preventive actions until completion.

• Oversee improvement initiatives and communicate progress, outcomes, and risks to leadership.

• Contribute to a better member experience, service quality, and regulatory preparedness.

⛳️ Requirements

• Bachelor's degree or an equivalent combination of education and experience.

• More than 3 years of experience in healthcare compliance, regulated healthcare operations, grievance administration, quality improvement, accreditation support, licensing, or a related field.

• Proven experience in coordinating investigations, grievances, audit readiness activities, or corrective action processes.

• Strong organizational abilities and project management capabilities.

• Capacity to handle multiple priorities and meet deadlines effectively.

• Exceptional written and verbal communication skills.

• Proficiency in Excel, Salesforce, case management systems, or other relevant business technologies and reporting tools.

• Ability to exercise sound judgment, uphold confidentiality, and work autonomously.

• Familiarity with the Knox-Keene Health Care Service Plan Act, DMHC requirements, CMS programs, Medicare, Medicaid managed care, or similar regulatory frameworks.

• Experience in supporting regulatory filings, accreditation reviews, audits, or ongoing compliance readiness.

• Background in investigating or managing healthcare grievances, service complaints, or quality issues.

• Knowledge of quality improvement methodologies, root cause analysis, and corrective action planning.

• Experience in enhancing operational processes to improve compliance, efficiency, and consistency.

• Strong attention to detail is essential.

• Proficient critical thinking and analytical skills.

• Excellent project and time management abilities.

• Capability to influence and work collaboratively across teams.

• Adaptability to a fast-paced, highly regulated environment.

• Ability to work from home with suitable lighting, computer, and phone access.

• Strong focus, attention to detail, problem-solving, and communication skills.

🏝️ Benefits

• Comprehensive training provided for effective job performance.

• Opportunities for career growth and advancement.

• Supportive and friendly supervisors and staff.

• Recognition for an award-winning team environment.

• Fully remote work arrangement available.

• Home office setup with necessary computer and phone access.