Job Title: Director of Quality & Compliance Division/Department Program

FLSA Status: FTE Exempt Reports to: VP of Strategy & Implementation

Direct Reports: Quality & Compliance Manager Indirect Reports: Quality & Compliance Specialists Data Entry Clerk

Position Overview

The Director of Quality & Compliance is an intermediate management role responsible for implementing the organization's mission, vision, and strategic priorities into actionable plans and measurable results. This role provides support for all programs and administration. This position bridges between the Quality & Compliance Department and the Senior Management Team. The Director of Quality & Compliance partners closely with the PRC Baker Places programs along with the Senior Management Team to achieve an excellent standard of client care and staff support.

Primary Duties and Responsibilities
• Develop, implement, and maintain agency-wide Quality Assurance (QA) and Quality Improvement (QI) policies, procedures, and performance improvement initiatives.
• Plan, oversee, and facilitate internal utilization reviews, clinical reviews, peer reviews, and PURQC chart audits to ensure compliance with regulatory and organizational standards.
• Serve as the agency's designated Privacy Officer, authorizing employee access to Electronic Health Record (EHR) systems, monitoring compliance with applicable privacy and confidentiality laws, and ensuring all staff complete required privacy and compliance training upon hire and annually thereafter.
• Manage medical records requests by developing and maintaining an efficient tracking and response system that ensures timely processing and regulatory compliance.
• Develop agency policies and procedures governing user access, security, and training for Electronic Health Record (EHR) systems and internal databases.
• Analyze qualitative and quantitative program data to identify opportunities for operational and clinical improvement, providing recommendations to leadership for quality enhancement.
• Monitor, track, and analyze adverse trends and organizational risks, developing corrective action plans, implementing quality improvement initiatives, and measuring outcomes to ensure sustained performance.
• Design, implement, and maintain clinical data collection, measurement, reporting, and analysis processes to support quality management and regulatory compliance.
• Develop preventive strategies to improve clinical documentation practices, optimize billable service reimbursement, and minimize claim denials and disallowances.
• Collaborate with Program Managers to ensure continuous survey and audit readiness for reviews conducted by DHCS, CCL, local agencies, accreditation bodies, and other regulatory entities.
• Develop and oversee a secure records management system to ensure closed clinical charts are properly archived, transported, and stored at approved off-site facilities in accordance with legal and organizational requirements.
• Prepare and present quarterly Quality Management (QM) reports and facilitate quarterly Quality Assurance/Quality Improvement meetings with the Senior Management Team and Program Directors.
• Perform additional duties and special projects as assigned in support of agency operations and strategic quality initiatives.

Minimum Qualifications
• Minimum of two (2) years of supervisory experience, preferably in Quality Management, Quality Assurance/Quality Improvement (QA/QI), Compliance, or a clinical behavioral health setting.
• Experience working in mental health outpatient and/or residential treatment programs preferred.
• Must qualify as a Mental Health Rehabilitation Specialist (MHRS) or hold an active license or registration in good standing with the California Board of Behavioral Sciences (BBS) or California Board of Psychology as one of the following: Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), Associate Clinical Social Worker (ASW), Associate Marriage and Family Therapist (AMFT), Associate Professional Clinical Counselor (APCC), Licensed Psychologist (Psy.D. or Ph.D.)
• Must successfully pass all required background clearances, including California Department of Social Services (CDSS), Federal Bureau of Investigation (FBI), and California Department of Justice (DOJ) criminal background checks, as a condition of employment.
• Thorough knowledge of California Medi-Cal Specialty Mental Health Services (SMHS), including documentation requirements, diagnosis, medical necessity criteria, treatment planning, and clinical documentation standards.
• Knowledge of California Drug Medi-Cal Organized Delivery System (DMC-ODS) requirements, including ASAM Criteria, levels of care, diagnosis, medical necessity, and documentation standards.
• Demonstrated experience ensuring compliance with Medi-Cal documentation requirements, county behavioral health contracts, and applicable federal, state, and local regulations.
• Experience conducting clinical record audits, utilization reviews, peer reviews, and quality assurance activities to evaluate compliance, documentation quality, and service delivery.
• Demonstrated ability to collect, analyze, and interpret qualitative and quantitative program data; develop key performance indicators (KPIs); identify trends; and implement quality improvement initiatives that improve clinical outcomes and operational performance.
• Experience developing, implementing, and monitoring corrective action plans and performance improvement strategies.
• Experience developing and implementing organizational policies, procedures, workflow processes, and operational practices that improve quality, compliance, efficiency, and risk management.
• Knowledge of healthcare privacy and confidentiality regulations, including HIPAA, 42 CFR Part 2, and applicable California privacy laws.
• Experience preparing organizations for audits, surveys, licensing reviews, and monitoring activities conducted by DHCS, county behavioral health departments, Community Care Licensing (CCL), accreditation organizations, and other regulatory agencies.
• Experience working with federal, state, county, and grant-funded program compliance, performance monitoring, and auditing requirements.
• Proficiency with Microsoft Office Suite (Word, Excel, Outlook, and PowerPoint) and Electronic Health Record (EHR) systems.
• Excellent written, verbal, interpersonal, facilitation, and presentation skills with the ability to effectively communicate across multidisciplinary teams and organizational leadership.
• Strong organizational, leadership, analytical, and critical thinking skills with the ability to manage multiple priorities, meet deadlines, and maintain high-quality work in a fast-paced environment.
• Demonstrated ability to collaborate effectively with internal departments, community partners, regulatory agencies, and external stakeholders.
• Demonstrated commitment to providing exceptional customer service, compassionate client care, ethical practice, and a recovery-oriented, person-centered approach to service delivery.
• Must maintain all required professional licenses or registrations in good standing (if applicable), annual TB clearance, and current First Aid/CPR certification.
• Ability to work flexible hours as needed, including occasional evenings, weekends, and holidays.

Salary and Benefits:

This is a full-time, exempt position. PRC offers a competitive salary plus medical, dental, and vision insurance for employees and their eligible spouse/children, as well as short/long-term disability, life insurance, employer-matching contributions to 403(b) retirement, generous paid time-off, California Bar dues, and professional development.