Position Summary: Reporting to the Senior Director of Quality Assurance, the Regional Quality Assurance Manager is responsible for facilitating and assuring in home care service provision is compliant with applicable Medicaid, Medicaid waiver, MCO, and other licensure and contractual requirements throughout assigned states.

Essential Duties:

• Develop, review, revise and implement standardized state specific policies, procedures and work processes that comply with Medicaid and other regulatory/contractual payer agreements
• Educate branch leadership and staff on state regulatory and contract requirements.
• Perform on-site and desktop audits and monitoring to assess branch level compliance with applicable rules and regulations.
• Oversee and support external agency audit processes including audit preparation, deficiency remediation and corrective action planning.
• Monitor corrective action execution and drive accountability.
• Drive operational compliance and quality outcomes.
• Report internal and external audit findings at all levels including branch, regional and senior leadership.
• Facilitate investigation, reporting and resolution of critical incidents and complaints.
• Investigate requests for recoupments by reviewing records and documentation.
• Performs other duties as assigned

Position Requirements & Competencies:

• Bachelor’s Degree in Business, Social Services, Public Administration, Nursing or a related field of study
• 3 – 5 years of experience in health care, social services or a related industry
• Audit experience is preferred
• Some experience in a large, fast-paced, results-driven, multi-site organization
• Must possess strong communication, written, interpersonal and organizational skills
• Proficiency in using Microsoft Word, Excel, PowerPoint and Outlook, required.
• Ability to travel up to 50%. Position may work remotely.
• Must be self-confident, thorough, and prompt in completing assignments and projects
• Passionate, energetic, tenacious and resolute, with a high sense of urgency and a strong drive to produce results
• Valid Driver’s License
• Fully vaccinated against COVID-19

To apply via text, text 2180 to (334) 518-4376

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