Quality Improvement & Compliance Manager

Alhambra, CA. Posted 2 months ago

The role

The Quality Improvement & Compliance Manager translates quality and compliance strategy into day-to-day execution. This person manages compliance risk, grievance investigations, regulatory monitoring, and corrective actions.

What you will do

Execute the annual QIC monitoring and audit plan
Review findings for severity, frequency, regulatory exposure, and participant impact
Own grievance administration including fact-finding and interviews
Translate CMS, DHCS, and other regulatory requirements into monitoring tools
Conduct compliance reviews and support departments in implementing requirements
Ensure CAPs identify root cause, owner, due date, and effectiveness evidence
Coordinate internal audit readiness and support CMS/DHCS audits
Directly supervise the QIC Coordinator
Review dashboards and trends and support PIPs
Identify QIC workflows suited for AI/automation

Required qualifications

Bachelor's degree in healthcare administration, public health, nursing, quality, business, or related field (equivalent substantial experience considered)
4+ years of healthcare quality, compliance, regulatory, managed-care, or clinical operations experience
Experience conducting audits or investigations, and managing corrective actions and regulatory deadlines
Supervisory, project leadership, or team-lead experience

Nice to have

Professional verbal fluency in Mandarin and Cantonese
PACE experience
CMS/DHCS regulatory experience
Grievance/appeals/participant-rights investigation experience
Clinical license or quality/compliance certification

Benefits

Medical, Dental, and Vision benefits for you and your family
Life Insurance and Disability Benefits
Parental and Caregiver Leave
Lunch, as well as delicious snacks and coffee
Paid Time Off across holidays, vacation time, personal days, and sick days
401k Plan
Personal and professional development, including CME support and career growth opportunities
Subscriptions and training on using AI tools including ChatGPT

About the company

Seen Health is a culturally-focused, technology-enabled healthcare organization that integrates medical care and social support through the PACE model. The mission is to empower seniors to age-in-place with dignity.