Sr. Manager, Quality Assurance and Compliance

Senior Manager of Quality Assurance & Compliance Responsible for establishing, maturing, and overseeing an effective quality and compliance program across all operational areas of the organization. Works as the second line of defense to ensure regulatory adherence and operational excellence. Responsibilities Develop and implement a comprehensive quality assurance program, including audit methodologies, KPIs, standards, and issue‑resolution processes. Coordinate accurate and timely submission of audit data, readiness documentation, and operational reporting. Partner with Operations leadership to align workflows, remove performance barriers, and launch initiatives that improve member satisfaction. Monitor, analyze, and communicate performance trends and KPIs to senior leadership for strategic planning and resource allocation. Establish governance frameworks and audit mechanisms to achieve organizational quality and compliance goals. Lead, mentor, and grow a team of QA and compliance professionals, fostering a culture of innovation, learning, and continuous improvement. Identify trends, opportunities for process improvement, and training needs; develop action plans and ensure a closed‑loop remediation process. Track and adapt to industry trends, regulatory changes, and evolving policies affecting compliance and operational functions. Supervise, hire, and manage team performance, including corrective actions and performance reviews. Qualifications Bachelor’s degree required; Master’s degree or equivalent experience preferred. Audit certification preferred. Minutes to 5 years of QA and compliance experience in Medicare/Medicaid operations. 3+ years of management experience in a healthcare environment, preferably Medicare Advantage. Minimum of 8 years progressive experience in healthcare or health‑plan operations. Proven experience managing a QA or audit team. Experience leveraging AI or machine‑learning tools to streamline QA processes. Deep knowledge of operational areas such as claims, provider data, benefits, enrollment, appeals, and grievances. Strong familiarity with CMS and state regulations and their operational implications. Demonstrated leadership, strategic thinking, problem‑solving, business insight, communication, analytical skills, and strong time‑management capabilities. Benefits Base salary range: $125,400 to $181,419 per year. Mostly remote work. Annual employee bonus program. Robust wellness program. Generous paid‑time‑off (PTO). Eleven paid holidays, one floating holiday, and one birthday holiday per year. 401(k) retirement plan with employer match and contribution. Employee recognition program. Tuition reimbursement. Equal Opportunity Employer Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity, marital status, disability, protected veteran status, or any other status protected by law. A background check is required. #J-18808-Ljbffr SHPCA SCAN Health Plan