Quality Assurance Manager

The Quality Assurance Manager will lead agency-wide quality, compliance, and utilization management initiatives, ensuring regulatory compliance and driving clinical excellence. The ideal candidate has deep knowledge of CMS regulations and strong leadership skills.

Requirements

• Provide leadership and oversight for Quality Assurance, Performance Improvement (QAPI), and Utilization Review programs for home health and hospice
• Ensure compliance with CMS Conditions of Participation, state regulations, accreditation standards, and payer requirements
• Oversee utilization review processes to ensure medical necessity, appropriate level of care, and regulatory compliance
• Lead survey readiness efforts and serve as a key resource during state, CMS, and accreditation surveys
• Analyze quality data, outcomes, denials, trends, and audit findings, develop corrective action plans and monitor effectiveness
• Collaborate with clinical leadership to improve documentation quality, care planning, and interdisciplinary coordination
• Provide guidance and oversight related to OASIS accuracy, hospice eligibility, and regulatory documentation standards
• Develop, implement, and maintain QA/UR policies, procedures, and education programs
• Support coding, billing, and reimbursement integrity initiatives
• Stay current on regulatory changes impacting home health and hospice and proactively implement organizational responses

Benefits

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Training & development
• Vision insurance

Originally posted on Himalayas