Quality Manager

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Lead the quality and compliance initiatives, workplans, and operational processes specific to New Jersey.

• Act as the subject-matter expert for quality, compliance, contract obligations, and payer expectations in New Jersey.

• Collaborate with operational and clinical teams to integrate quality and compliance into everyday operations, onboarding, supervision, and service delivery.

• Keep up-to-date with New Jersey DDD requirements and documentation standards, translating these into workflows and training materials.

• Work alongside billing and finance teams to assess claims quality, address denials, recoupments, and audit activities, while driving corrective measures.

• Manage payer audit preparations and responses, including requests for medical records as well as pre- and post-payment reviews.

• Assist in identifying, documenting, and resolving potential overpayments.

• Supervise the New Jersey incident management process, ensuring timely reporting and tracking of reportable incidents.

• Lead or assist in investigations and root-cause analyses for incidents, complaints, and grievances.

• Create and oversee Plans of Correction following investigations.

• Coordinate accreditation and external reviews as necessary.

• Design and implement New Jersey audit and monitoring plans that encompass documentation, authorizations, contract deliverables, incidents, credentials, and billing support.

• Establish and track quality and compliance dashboards and key performance indicators (KPIs).

• Provide regular reports to leadership and escalate significant risks and trends as needed.

• Represent quality and compliance during interactions with New Jersey payers, DDD, and contract partners upon request.

• Report to the EVP of Quality & Compliance and collaborate with operational, clinical, finance/billing, HR, and legal teams.

⛳️ Requirements

• Bachelor’s degree in Healthcare Administration, Business, Nursing, Social Work, Public Health, Quality, Compliance, or a related discipline.

• Over 5 years of progressive experience in healthcare quality and compliance.

• Direct experience with payer requirements, contract compliance, and incident reporting within a regulated environment.

• Preferred experience in behavioral health, I/DD, HCBS, or a comparable setting.

• Strongly preferred familiarity with New Jersey DDD, Medicaid Waiver, or NJ FamilyCare requirements.

• Knowledge of compliance programs, auditing and monitoring processes, credentialing, corrective actions, and training initiatives.

• Proficient understanding of New Jersey incident reporting requirements, background check/CARI processes, and mandatory reporting laws.

• Capability to interpret contracts, payer manuals, and regulations, translating them into practical operational procedures.

• Excellent communication, collaboration, project management, and analytical abilities.

• Capacity to influence and work effectively across various teams.

🏝️ Benefits

• Comprehensive benefits package.

• Competitive health, dental, and wellness coverage.

• Eligibility for 401(k) after 12 months.

• Full-time position.