SCAN · 6 hours ago
Sr. Manager, Quality Assurance and Compliance
United States
Full-time
Remote
Senior Level, Lead/Staff
$125K/yr - $181K/yr
8+ years expSCAN Group is a not-for-profit organization dedicated to tackling pressing issues facing older adults in the United States. The Senior Manager of Quality Assurance and Compliance is responsible for establishing and maturing an effective quality and compliance program across operational areas, ensuring adherence to regulations and maintaining high quality standards in operations.
Elder CareHealth CareHome Health CareMedical
Responsibilities
Responsible for developing and implementing a quality assurance program, reviewing audits meet accuracy, timeless and contractual obligations, and enhancing operational processes
Partner with Ops leadership to design and develop an effective Quality Assurance and Compliance program gaining alignment on methodology, audit approach, KPIs, standards and issue resolution process
Manage quality and Compliance reporting. Coordinate accurate and timely submission of data, including audit readiness and documentation standards for Operations
Collaborate with operational partners to align workflows, address barriers to performance, and implement initiatives to enhance operations and member satisfaction
Monitor and communicate performance trends track and analyze key performance indicators (KPIs). Share actionable insights and recommendations with senior leadership to inform strategic planning and resource allocation
Establish effective governance framework to include Audit the Auditor mechanism to achieve organizational goals related to quality and compliance
Lead a team of quality assurance and compliance professionals mentoring, fostering positive team culture, promote leadership growth, encourage innovation, and continuous learning to achieve team or individual goals
Identifying trend and areas of opportunity for process improvements and additional training Work closely with operations leadership to review finding, develop action plans and remediate issues
Partner with operational leadership to review finding, develop corrective action plans, and remediate identified issues to the root cause ensuring a closed loop process
Monitor industry trends, regulatory changes and current events to ensure team remains informed and adapts to evolving policies and procedures
Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)
Actively support the achievement of SCAN’s Vision and Goals
Other duties as assigned
Qualification
Required
Bachelor's Degree required
5 years of related experience QA and compliance operations experience with Medicare and Medicaid
3+ years' management experience in healthcare environment, preferably Medicare Advantage
8+ years of progressive experience in healthcare operations
Experience managing Quality Assurance and/or Operations audit team
Deep experience in operational areas such as claims, configuration, provider data, benefits, enrollment, appeals and grievances
Proven success leading quality and compliance in a matrixed environment
Strong working knowledge of CMS and state regulations and operational implications
Leadership - Skilled to develop others
Problem Solving - Make critical decisions, often involving high-level risk assessment and the ability to adapt to changing circumstances
Strategic Mindset - Formulates strategy and maps steps to achieve strategic goals
Business Insight - In-Depth understanding of the business
Oral and written communication skills
Strong analytical and critical thinking skills
Detail oriented, organized and strong time management skills
Preferred
Graduate or Advanced Degree or equivalent experience preferred
Audit Certification preferred
Experience working with AI or other machine learning tools to assist with streamlining QA processes
Benefits
An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
Excellent 401(k) Retirement Saving Plan with employer match and contribution
Robust employee recognition program
Tuition reimbursement
Company
SCAN
About SCAN Keeping Seniors Healthy and Independent–that’s been our mission for more than 40 years.
1001-5000 employees
H1B Sponsorship
SCAN has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (5)
2024 (3)
2023 (6)
2022 (6)
2021 (5)
2020 (6)
Funding
Current Stage
Late StageLeadership Team
Lyn Amor Macaraeg
CVP Chief of Staff & Strategic Advisor to the CEO
Sachin H. Jain, MD, MBA
President and CEO, Board Director
Recent News
2025-12-26
Company data provided by crunchbase