Sr. Manager, Quality Assurance and Compliance
Core
Establishing and maturing an effective quality and compliance program across operational areas to ensure adherence to regulations and high quality standards.
Role type
Senior Manager, Quality Assurance and Compliance
Builds
Quality assurance and compliance programs, audit frameworks, and governance mechanisms for healthcare operations.
Domain
Healthcare / Health Plan Operations (Medicare Advantage, Medicaid)
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
QA and compliance operations experience, Medicare and Medicaid regulatory knowledge, management experience in healthcare, team leadership, audit management, CMS and state regulations knowledge, strategic planning, risk assessment, process improvement, claims and enrollment operations knowledge.
Preferred skills
Audit certification, experience with AI or machine learning tools for QA processes, graduate or advanced degree.
Technologies
AI, machine learning tools
Responsibilities
Develop and implement quality assurance programs, partner with operations leadership to design compliance methodologies, manage quality and compliance reporting, monitor and analyze KPIs, establish governance frameworks including audit mechanisms, lead and mentor QA/compliance teams, identify process improvement opportunities, remediate identified issues, monitor industry trends and regulatory changes.
Seniority
Senior, hands-on IC with management responsibilities