Head of Clinical Quality and Regulatory

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

📋 Description

• Oversee enterprise clinical quality, patient safety, management of critical incidents, quality of care, regulatory readiness, and accreditation programs.

• Establish strategy, operating model, standards, governance cadence, and accountability frameworks for a uniform quality function nationwide.

• Guide, mentor, and develop Clinical Quality & Regulatory Managers aligned with regional needs.

• Oversee recruitment, onboarding, performance evaluations, career progression, regional coverage, and workload distribution.

• Collaborate with Clinical Operations, Practice Operations, field leaders, the COO, and senior clinical operations leadership on enterprise quality, accreditation, and risk initiatives.

• Ensure prompt execution and completion of incident reporting and lifecycle management processes.

• Uphold incident classification and reporting standards while consolidating regional findings into overarching enterprise themes and risk perspectives.

• Prioritize investments in corrective actions and confirm sustained improvements.

• Supervise enterprise morbidity and mortality discussions.

• Direct accreditation audits, state licensure evaluations, regulatory readiness, market responses, and develop plans for corrections until validated closure.

• Define and implement medical necessity chart audits and assist with payer audit countermeasures.

• Maintain continuous readiness for surveys and ensure organized supporting documentation.

• Collaborate with Compliance and Legal to clarify boundaries between clinical documentation, medical necessity review, and billing accuracy.

• Monitor regulatory and accreditation updates and convert them into actionable operational guidance.

• Prepare and deliver quality reports to enterprise governance forums and facilitate board-level reporting.

• Manage and standardize peer review processes and committee documentation.

• Secure executive sponsorship for the regional triad model.

• Act as an escalation point for managers.

• Handle a defined regional portfolio, encompassing chart audits, investigations, trend analysis, and countermeasure initiatives.

• Investigate sentinel-level events, significant legal or reputational risks, and cross-regional trends.

• Provide coverage for the quality team during leaves, vacancies, or increased workloads.

• Establish the Quality team reporting cadence and conduct quarterly enterprise roll-ups.

• Work with analytics and technology teams to develop platform-based workflow solutions.

• Utilize process mapping, root cause analysis, and countermeasure development.

• Represent clinical quality needs in enterprise systems projects, including EHR transitions and measurement-based care initiatives.

• Travel up to 50% to supported regions for audits, survey assistance, and leadership engagement.

⛳️ Requirements

• Master’s degree in a behavioral health discipline, nursing, or a related clinical field.

• A minimum of ten years in behavioral health service delivery, clinical quality, or clinical operations.

• Experience with executive-level accountability for quality strategy, regulatory oversight, performance improvement, and risk management in complex healthcare settings.

• At least six years of leadership experience managing directors, managers, and/or cross-functional teams.

• Proven success in influencing executive stakeholders, spearheading large-scale quality transformation initiatives, and nurturing leadership pipelines.

• Demonstrated history of hiring, coaching, and developing clinical or quality professionals.

• Experience leading activities related to regulatory readiness, accreditation, state licensure, and payer audits concerning clinical quality and documentation.

• Expertise in developing and executing corrective action plans that ensure sustained compliance.

• Ability to analyze and present quality data effectively to executive and board-level audiences.

• Willingness to engage in selected direct casework alongside leadership duties.

• Legally authorized to work in the United States.

• Possess awareness, inclusivity, sensitivity, humility, and experience working with diverse populations.

• Preference for candidates with multi-state or national behavioral health experience.

• Preferred experience with Joint Commission or multi-state survey leadership.

• Lean or Six Sigma green or black belt certification preferred.

• CPHQ or similar quality credentials or experience preferred.

• Familiarity with peer review, credentialing and privileging, and focused or ongoing professional practice evaluations preferred.

• Experience implementing a quality, incident, or risk management platform preferred.

• Residence in one of the supported regions is preferred.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Accidental Death & Dismemberment (AD&D) insurance.

• Short- and long-term disability insurance.

• Life insurance.

• 401k retirement plan with employer matching.

• Paid parental leave.

• Paid time off.

• Holiday pay.

• Employee Assistance Program.

• Bonus and equity potential.

• Reasonable accommodations for disabilities.