Quality Manager

Job not on LinkedIn

🔥 0 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $60k - $65k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

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Abound Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1997

💼 Consulting

🏥 Healthcare

🤝 Non-profit

Consulting • Healthcare • Non-profit

Abound Health is dedicated to empowering individuals of all ages with intellectual and developmental disabilities (I/DD) and complex medical needs. They offer a range of services including group homes, supported employment, and specialized consultative services, all centered on person-centered care. Their mission emphasizes the importance of advocacy, inclusion, and supporting not only individuals but also their families and staff.

📋 Description

• Lead New Jersey-specific quality and compliance priorities, workplans, and operating processes • Serve as the New Jersey subject-matter lead for quality, compliance, contract requirements, and payer expectations • Partner with operations and clinical teams to embed quality and compliance into daily operations, onboarding, supervision, and service delivery • Maintain knowledge of New Jersey DDD requirements and documentation standards and translate requirements into workflows and training • Partner with billing and finance to monitor claims quality, denials, recoupments, and audit activity and drive corrective actions • Oversee payer audit preparation and responses, including medical record requests and pre- and post-payment reviews • Support the identification, documentation, and resolution of potential overpayments • Oversee the New Jersey incident management process, including timely reporting and tracking of reportable incidents • Lead or support investigations and root-cause analysis for incidents, complaints, and grievances • Develop and monitor Plans of Correction following investigations • Coordinate accreditation and external reviews as applicable • Design and execute New Jersey audit and monitoring plans covering documentation, authorizations, contract deliverables, incidents, credentials, and billing support • Establish and monitor quality and compliance dashboards and KPIs • Provide routine reporting to leadership and escalate material risks and trends • Represent quality and compliance in New Jersey payer, DDD, and contract partner interactions as requested • Report to the EVP of Quality & Compliance and partner 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 field • 5+ years of progressive experience in healthcare quality/compliance • Direct experience with payer requirements, contract compliance, and incident reporting in a regulated environment • Experience in behavioral health, I/DD, HCBS, or a similar setting preferred • Experience with New Jersey DDD, Medicaid Waiver, or NJ FamilyCare requirements strongly preferred • Knowledge of compliance programs, auditing/monitoring, credentialing, corrective action, and training programs • Working knowledge of New Jersey incident reporting requirements, background check/CARI processes, and mandatory reporting laws • Ability to interpret contracts, payer manuals, and regulations and translate them into practical operational processes • Strong communication, collaboration, project management, and analytical skills • Ability to influence and collaborate effectively across teams

🏖️ Benefits

• Comprehensive benefits package • Competitive health/dental/wellness coverage • 401(k) eligibility after 12 months • Full-time position