Quality Manager – Remote in NJ

Abound Health is seeking a Quality Manager to join our team in New Jersey This role is responsible for leading the day to day execution of Abounds quality regulatory payer and contract compliance programs across New Jersey operations Reporting to the EVP of Quality & Compliance the Quality Manager partners with operational clinical financebilling HR and legal teams to ensure compliance with state and federal requirements payer policies and contractual obligations This is a remote role for applicants who live in NJ Key ResponsibilitiesLead New Jersey specific quality and compliance priorities workplans and operating processesServe as the New Jersey subject matter lead for quality compliance contract requirements and payer expectationsPartner with operations and clinical teams to embed quality and compliance into daily operations onboarding supervision and service deliveryMaintain knowledge of New Jersey DDD requirements and documentation standards and translate requirements into workflows and trainingPartner with billing and finance to monitor claims quality denials recoupments and audit activity and drive corrective actionsOversee payer audit preparation and responses including medical record requests and pre and post payment reviewsSupport the identification documentation and resolution of potential overpaymentsOversee the New Jersey incident management process including timely reporting and tracking of reportable incidentsLead or support investigations and root cause analysis for incidents complaints and grievancesDevelop and monitor Plans of Correction following investigationsCoordinate accreditation and external reviews as applicableDesign and execute New Jersey audit and monitoring plans covering documentation authorizations contract deliverables incidents credentials and billing supportEstablish and monitor quality and compliance dashboards and KPIsProvide routine reporting to leadership and escalate material risks and trendsRepresent quality and compliance in New Jersey payer DDD and contract partner interactions as requestedQualificationsBachelors degree in Healthcare Administration Business Nursing Social Work Public Health Quality Compliance or a related field; Masters degree preferred5 years of progressive experience in healthcare qualitycomplianceDirect experience with payer requirements contract compliance and incident reporting in a regulated environmentExperience in behavioral health IDD HCBS or a similar setting preferredExperience with New Jersey DDD Medicaid Waiver or NJ FamilyCare requirements strongly preferredKnowledge of compliance programs auditingmonitoring credentialing corrective action and training programsWorking knowledge of New Jersey incident reporting requirements background checkCARI processes and mandatory reporting lawsAbility to interpret contracts payer manuals and regulations and translate them into practical operational processesStrong communication collaboration project management and analytical skillsAbility to influence and collaborate effectively across teamsCompensation & BenefitsThe target base salary range for this full time position is 60000 65000 Base pay is determined by factors such as location experience job related skills and relevant training Total compensation includes a comprehensive benefits package competitive healthdentalwellness coverage and 401k eligibility after 12 months Contact your Talent Acquisition Partner for more information Equal Employment OpportunityAbound Health is an equal opportunity employer We evaluate all qualified applicants without regard to race color religion gender national origin age sexual orientation gender identityexpression veteran status disability or any other legally protected characteristic li remote