EAP Compliance and Quality Program Coordinator

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🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

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Health Advocate

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

📣 Marketing

Healthcare • Consulting • Marketing

Health Advocate is a company dedicated to making healthcare easier for organizations and their members. Utilizing a combination of personal support, data, and technology, they offer a whole-person approach to improve health outcomes, reduce absenteeism and presenteeism, and lower costs. Their services include health advocacy and navigation, clinical care management, emotional health support, and personalized well-being programs. Health Advocate caters to over 12,500 organizations, offering 24/7 support in over 250 languages and ensuring HIPAA compliance and NCQA certification.

📋 Description

• Coordinate regulatory reporting, documentation, filing requirements, and compliance calendars associated with the Knox-Keene license • Monitor regulatory and legislative updates and communicate impacts to leadership and stakeholders • Support audit readiness through documentation collection, evidence preparation, and regulatory follow-up • Maintain records of filings, inquiries, corrective actions, and regulatory commitments • Identify compliance risks and recommend actions or escalations • Monitor grievances from intake through closure, including tracking, documentation, investigation, and resolution • Conduct investigations and manage non-clinical grievance communications • Prepare compliant grievance correspondence and maintain case documentation • Analyze grievance trends and recommend process improvements, training opportunities, and corrective actions • Coordinate day-to-day compliance, grievance, and quality program activities • Maintain workplans, dashboards, tracking tools, action-item logs, and regulatory calendars • Monitor deadlines, dependencies, and risks; escalate concerns as needed • Prepare materials and documentation for compliance and quality meetings • Provide leadership updates on compliance activities, grievance trends, and quality initiatives • Liaise with clinical leadership, operations, legal counsel, Provider Relations, and other stakeholders • Improve reporting processes, documentation standards, and workflow efficiency • Assist with compliance, audit, grievance, and reporting training and education • Support accreditation and compliance initiatives across business areas • Analyze compliance, grievance, and service data to identify trends and improvement opportunities • Support root cause analysis and track corrective and preventive actions through completion • Monitor improvement initiatives and communicate progress, outcomes, and risks to leadership • Contribute to improved member experience, service quality, and regulatory readiness

🎯 Requirements

• Bachelor's degree or equivalent combination of education and experience • 3+ years of experience in healthcare compliance, regulated healthcare operations, grievance administration, quality improvement, accreditation support, licensing, or a related field • Experience coordinating investigations, grievances, audit readiness activities, or corrective action processes • Strong organizational and project management skills • Ability to manage multiple priorities and deadlines • Excellent written and verbal communication skills • Proficiency with Excel, Salesforce, case management systems, or similar business technology and reporting tools • Ability to exercise sound judgment, maintain confidentiality, and work independently • Familiarity with the Knox-Keene Health Care Service Plan Act, DMHC requirements, CMS programs, Medicare, Medicaid managed care, or similar regulatory frameworks • Experience supporting regulatory filings, accreditation reviews, audits, or ongoing compliance readiness • Experience investigating or managing healthcare grievances, service complaints, or quality concerns • Knowledge of quality improvement methodologies, root cause analysis, and corrective action planning • Experience improving operational processes to enhance compliance, efficiency, and consistency • Strong attention to detail • Critical thinking and analytical skills • Excellent project and time management • Ability to influence and collaborate across teams • Adaptability in a fast-paced, highly regulated environment • Ability to work in a home office with appropriate lighting, computer, and phone access • Strong concentration, attention to detail, problem-solving, and communication skills

🏖️ Benefits

• Training provided to do the job well • Room to grow and opportunities for advancement • Supportive and friendly supervisors and staff • Award-winning team environment • Fully remote work arrangement • Home office environment with computer and phone access