Quality and Compliance Manager

Position Title: Quality and Compliance Manager

Department: Compliance

Reports To: VP of Quality and Compliance

Location: California (Hybrid)

Employment Type: Full-time Exempt

Travel Requirement: 20%

Position Overview

The Quality & Compliance Manager is responsible for designing, implementing, and monitoring the organization's compliance and regulatory risk control frameworks across in-home healthcare operations. Reporting directly to the VP of Quality & Compliance, this role serves as a central resource for ensuring that MedZed's programs, contracts, and internal processes adhere to federal and California state regulatory requirements - including Medi-Cal, IHSS, CBAS, and applicable managed care contract obligations. The Program Manager leads cross-functional compliance initiatives, tracks corrective action plans, and supports audit readiness across all service lines.

Key Responsibilities

Compliance Monitoring & Regulatory Risk

• Design and maintain a regulatory compliance monitoring calendar covering DHCS, DMHC, CMS, and applicable county contract requirements.
• Conduct ongoing monitoring of federal and California regulatory changes; assess operational impact and drive timely policy updates.
• Develop and manage risk matrices for regulatory and contract obligations; escalate material risks to the VP of Quality & Compliance.
• Coordinate responses to regulatory inquiries, desk reviews, and on-site surveys; prepare supporting documentation and track findings to resolution.
• Monitor compliance with Medi-Cal managed care contract terms, IHSS program requirements, and other payer or county obligations.

Internal Compliance Controls

• Build and maintain an internal compliance controls library, including policies, procedures, attestations, and audit tools.
• Conduct routine internal audits and testing across clinical operations, billing, documentation, and vendor management.
• Lead root cause analysis for compliance findings; develop and track corrective action and performance improvement plans (CAPs/PIPs).
• Coordinate with department managers to embed compliance controls into day-to-day workflows and onboarding processes.
• Maintain compliance issues log and produce monthly dashboards for leadership review.

Contract Risk Management

• Review and assess new and renewing contracts for compliance risk, including payer agreements, subcontractor arrangements, and vendor contracts.
• Maintain contract obligations tracker; monitor adherence to reporting deadlines, notice requirements, and performance standards.
• Partner with legal counsel and operations on contract language related to HIPAA, scope of services, and regulatory compliance.
• Support rate negotiations and program expansions with compliance impact analyses.

Training & Culture

• Develop and deliver compliance training for Community Health Navigators (CHNs) and program staff, including annual and role-specific curricula.
• Maintain a training completion tracking system and report gaps to the VP of Quality & Compliance.
• Act as a day-to-day compliance resource for field staff, responding to questions and escalating issues as appropriate.

Reporting & Documentation

• Prepare compliance reports, board updates, and regulatory submissions as directed by the VP.
• Maintain organized, audit-ready compliance records and documentation in accordance with retention policies.

Qualifications

Required Experience

• 3+ years of direct experience in compliance monitoring, regulatory risk controls, and contract risk management in a healthcare setting.
• 3+ years managing internal compliance controls, including audit functions, corrective action plans, and controls documentation.
• Demonstrated knowledge of California healthcare regulatory environment, including Medi-Cal, DHCS requirements, and managed care contract compliance.
• Experience working in or alongside in-home healthcare, community-based services, or a similar field-operations model strongly preferred.

Education

• Bachelor's degree in healthcare administration, Public Health, Business Administration, or a related field required.
• Master's degree (MHA, MPH, MBA) or Juris Doctor preferred.
• Certified in Healthcare Compliance (CHC) through the Health Care Compliance Association (HCCA) or Certified Internal Auditor (CIA) through the Institute of Internal Auditors preferred.

Skills & Competencies

• Demonstrated ability to manage multiple workstreams in a dynamic program management environment.
• Ability to work with and through others in a matrixed leadership role.
• Strong command of federal healthcare regulations, including HIPAA, ACA, and Medi-Cal managed care rules.
• Skilled in building and managing compliance frameworks, risk matrices, and audit programs from the ground up.
• Ability to translate regulatory requirements into clear, operational policies and staff-facing training.
• Excellent written and verbal communication; able to present complex compliance information to non-technical audiences.
• Proficient in Microsoft 365 (Excel, Word, SharePoint); experience with compliance management systems or GRC platforms a plus.
• Bilingual (English/Spanish) a plus given the populations MedZed serves.

Physical Requirements

• This position requires the employee to remain in a stationary position for prolonged periods while performing desk-based computer tasks.
• The employee must be able to constantly operate a computer, keyboard, and other office productivity machinery, such as a calculator, copy machine, and computer printer.
• The person in this position may need to occasionally move about inside the office/remote workspace to access file cabinets, office machinery, or other resources.
• The employee may occasionally be required to lift and move objects weighing up to 10 pounds (e.g., a laptop, files, or small office equipment).
• Clarity of vision at approximately 20 inches or less is required for working with computers and reading small print.

Work environment & Conditions.

This is a hybrid position based in California. The Quality and Compliance Manager is expected to be available for periodic on-site visits to operational locations, county meetings, and regulatory site visits. Some evening or weekend availability may be required during audit or survey periods. Travel within California up to 20%.