Senior Manager, Clinical Quality
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Job Description
Senior Manager overseeing clinical quality assurance frameworks for a tech-powered family caregiving platform. Ensuring compliance and high-quality care across multiple states.
Responsibilities:
- Design, implement, and evaluate Abby Care’s multi-state Clinical Quality Improvement (CQI) and Quality Assurance (QA) programs.
- Partner closely with state Directors of Nursing and Clinical Leads to standardize clinical practices across all active and upcoming markets.
- Build a deeply rooted organizational culture that prioritizes patient safety, exceptional care, and caregiver compliance.
- Serve as the internal subject matter expert on state-specific Medicaid paid family caregiving regulations, Electronic Visit Verification (EVV), and Home Health Agency (HHA) scope of practice.
- Maintain and guarantee perpetual audit-readiness for state Departments of Health (DOH), CMS, and commercial payer reviews.
- Deliver targeted remediation training and policy updates to clinical leadership when compliance gaps or regional regulatory updates occur.
- Oversee corporate charting standards and multi-state clinical audit frameworks.
- Establish performance benchmarks for electronic charting, ensuring clinical necessity is robustly documented to protect authorization utilization and minimize compliance risk.
- Analyze complex clinical data and Key Performance Indicators (KPIs), including patient readmission rates, extended visit trends, and clinical incident reports, to drive meaningful interventions and workflow improvements.
- Oversee the formal escalation, investigation, and reporting of all critical incidents across operations.
- Ensure thorough Root Cause Analyses (RCA) are completed for variances and promptly deploy sustainable Corrective Action Plans (CAPs).
Requirements:
- Bachelor of Science in Nursing (BSN) required; Master’s degree in Nursing (MSN), Healthcare Administration (MHA), or Public Health (MPH) preferred.
- Current, active, and unencumbered license as a Registered Nurse (RN). Multi-state/Compact licensure is highly preferred, or a willingness to rapidly obtain licensure in upcoming expansion states.
- Minimum of 5 years of licensed clinical nursing experience, with at least 2–3 years in home health care, community health, or managed care environments.
- Minimum of 2 years of dedicated, proven experience in clinical quality management, healthcare compliance, or utilization review.
- Deep knowledge of OASIS, Home Health Agency (HHA) regulations, and CMS/Medicaid audit processes is highly preferred.
- Ability to work flexible hours to match the urgent needs of an evolving startup market, with a willingness to travel locally/regionally as required for state audits and clinical evaluations.
Benefits:
- Competitive compensation packages that reflect the value you bring. We reward our team for the impact of their work – full-time employees are eligible for an annual company performance bonus.
- Comprehensive health coverage that works for you. Choose from high-quality medical dental and vision options, including a $0 deductible PPO and a company-funded HSA, alongside employer-paid life and disability insurance.
- Generous paid time off. We provide policies that allow you to recharge along with 10 paid company holidays.
- Financial savings benefits to support your future. We support your financial well-being with HSA contributions, optional FSA and commuter benefits, and full coverage of all 401(k) account fees (employer match not currently offered).
- Paid parental leave to support your growing family. We provide paid leave, so you can focus on bonding and adjusting to life as your family grows.
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