Director of Quality and Compliance – Healthcare

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $135k - $155k / year

⏰ Full Time

🔴 Lead

🚔 Compliance

👻 Ghost score 8%

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Holon Health

WebsiteLinkedInAll Job Openings

2 - 10 employees

Founded 2023

🏥 Healthcare

☁️ SaaS

💰 $200k Pre seed on 2023-11

Healthcare • SaaS

Holon Health is a healthcare provider focused on accessible, low-to-no-cost care and recovery support for people living with substance use disorder and related mental health concerns. They offer primary care, telehealth appointments, prescriptions, peer and recovery coaching, and 24/7 support through their Holon Vibe app, which also uses contingency management rewards for engagement. Holon serves clients directly and partners with courts, community organizations, health plans, and providers; their services are covered by Medicaid, Medicare, and most marketplace plans.

📋 Description

• Own all SOPs, state and health plan addenda, annual reviews, updates, and document control • Define compliance requirements, regulatory or contractual sources, and acceptance criteria for platform controls • Receive, triage, review, and manage incidents, accidents, deaths, and suspected abuse, neglect, or exploitation • Determine reportability and file external reports within applicable deadlines • Track follow-up reports, returned reports, confirmations, and closure • Escalate sentinel events and deaths to the Medical Director and CEO • Maintain incident rules tables and abuse hotline directories with approved change control • Ensure mandated reporter obligations are met and documented • Lead root cause analyses and corrective and preventive action plans • Present corrective actions to the HEQMC and track verified completion • Plan and run internal audits of clinical, billing, CoCM, RTM, consent, and telehealth documentation • Report audit findings, root causes, and corrective actions; track closure and re-audit • Coordinate pre-bill review findings and overpayment refunds with revenue cycle • Partner on SOP training, competency checks, staff briefings, and training records • Coordinate technology dependencies and interim operational controls with Product Development • Prepare responses to payer quality-of-care inquiries, audits, record requests, and corrective action requests • Monitor state Medicaid, health plan, CMS, privacy, and contract changes • Maintain state and health plan reporting portal accounts • Serve as HEQMC secretariat and prepare agendas, minutes, action logs, SOP approvals, and quarterly quality packs • Report quality and compliance metrics to the HEQMC and CEO • Support NCQA Health Equity Accreditation readiness and accreditation work

🎯 Requirements

• Clinical license (for example RN, LCSW, LPC); or bachelor’s degree in a health-related field; or bachelor’s degree in business, operations management, industrial engineering, or related field; or equivalent formal training in operations management, process improvement, or quality management • 7+ years of experience in healthcare quality, compliance, risk management, accreditation, operations management, or process improvement and quality management • Multistate compliance experience • Experience with regulatory reporting and compliance • Experience with incident or event management, root cause analyses, and corrective action plans • Experience writing and maintaining SOPs and training staff • Strong writing skills • Working knowledge of HIPAA Privacy and Security Rules and 42 CFR Part 2 • Comfort working in EHR or app-based workflows, dashboards, and spreadsheets • Healthcare quality, compliance, risk management, accreditation, operations management, or process improvement experience • Bonus: CHC, CPHQ, Lean Six Sigma Green Belt or higher, ASQ CQIA/CQE, mandated reporter duties, telehealth, behavioral health, integrated primary care, Collaborative Care, state Medicaid, NCQA accreditation, CoCM/RTM documentation and billing, health equity data stratification, or a master’s degree

🏖️ Benefits

• Annual leadership bonus • Unlimited PTO • Flexible schedules • Remote-first culture • Health, dental, vision, life, and disability benefits • 401(k) with company match • Space for self-care • Room to grow in a high-impact, mission-driven startup • Equal opportunity employer