Compliance Officer

Job Description

Job Description

At Nurturing Care, we are committed to enhancing lives by delivering compassionate, person-centered healthcare and social services to individuals and families facing social, medical, behavioral, and developmental challenges. Guided by integrity, persistence, and trust, we strive to provide exceptional care while maintaining the highest standards of quality, compliance, and accountability.

The Compliance Officer supports the organization's compliance and quality improvement initiatives by monitoring program operations, conducting documentation reviews, assisting with audits, maintaining compliance records, and ensuring adherence to federal, state, and contractual requirements. This role works collaboratively with leadership to promote regulatory compliance, improve service quality, and support continuous organizational improvement.

Essential Responsibilities

Compliance Monitoring

• Monitor program operations to ensure compliance with Nurturing Care policies, CalAIM requirements, Medi-Cal regulations, HIPAA, and contractual obligations.
• Review client records, assessments, care plans, progress notes, and supporting documentation for completeness, accuracy, and compliance.
• Identify documentation deficiencies and work with program staff to ensure timely corrective action.

Quality Assurance

• Conduct routine quality assurance reviews of case management, Enhanced Care Management (ECM), Community Supports, housing services, and other organizational programs.
• Track quality indicators and assist leadership in monitoring program performance.
• Prepare reports identifying trends and opportunities for improvement.
• Assist with utilization reviews and quality improvement initiatives.

Auditing & Reporting

• Participate and lead internal audits of documentation, billing support, and program operations.
• Assist with preparation for external audits conducted by Managed Care Plans, county agencies, DHCS, or other regulatory entities.
• Monitor corrective action plans and follow up to ensure timely resolution.
• Prepare compliance and quality reports for leadership.

Policy & Training Support

• Assist in maintaining organizational policies and procedures to reflect current regulatory requirements.
• Coordinate annual compliance training, including HIPAA, documentation standards, fraud and abuse prevention, and organizational policies.
• Support onboarding of new employees regarding compliance expectations.

Documentation & Billing Support

• Review documentation supporting Medi-Cal and CalAIM billing requirements.
• Collaborate with billing and program staff to improve documentation accuracy.
• Assist in identifying billing-related documentation issues prior to claim submission.

Collaboration

• Partner with Program Directors, Program Managers, Managing Partners and Human Resources to support compliance initiatives.
• Stay informed regarding changes to CalAIM, DHCS, Medi-Cal, HIPAA, and other applicable regulations.
• Promote a culture of accountability, continuous improvement, and ethical practice throughout the organization.

Qualifications

Required

• Bachelor's degree in Healthcare Administration, Public Health, Human Services, Social Work, Business Administration, or a related field.
• Minimum of 5 years of experience in healthcare, behavioral health, social services, quality assurance, compliance, case management, or program administration.
• Experience with Enhanced Care Management (ECM), Community Supports, case management, or behavioral health programs.
• Experience supporting internal audits or quality assurance initiatives.
• Experience reviewing documentation and maintaining accurate records.
• Working knowledge of:
• HIPAA Privacy Rules
• Medi-Cal and CalAIM programs
• Documentation standards
• Quality assurance principles
• Strong organizational skills with exceptional attention to detail.
• Excellent written and verbal communication skills.
• Proficiency with Microsoft Office and electronic health record (EHR) systems.
• Ability to maintain confidentiality and manage sensitive information.

Preferred

• Certified Professional in Healthcare Quality (CPHQ) or Certified in Healthcare Compliance (CHC) is preferred but not required.