Quality Manager
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Job Description
Quality Manager leading quality, regulatory, payer, and contract compliance for Abound Health’s New Jersey healthcare operations. Driving audits, incident management, corrective actions, and compliance reporting.
Responsibilities:
- 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
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