Quality and Compliance Officer
il y a 11 jours
Phoenix
Job Description:\n\n ABOUT ADOBE Adobe Population Health (APH) is a women-owned health solutions company founded in 2018 with a mission of positively impacting the lives we touch. Headquartered in Phoenix, AZ, with satellite locations across multiple states, APH fosters a culture rooted in inclusivity, human kindness, and high-quality care. Recognized by Inc. 5000 as one of America’s Fastest-Growing Private Companies and honored for a fifth consecutive year as a “Best Place to Work” by the Phoenix Business Journal, APH continues to expand its reach and impact. APH partners with health plans, providers, hospitals, and families to deliver tailored programs including case management, in-home and in-clinic wellness assessments, preventative care, transitional care, and social services. As one of the nation’s few fully integrated healthcare organizations, APH delivers comprehensive, coordinated medical and social support through a wide range of specialized service lines. With continued growth on the horizon, APH is seeking mission-driven individuals who are passionate about improving health outcomes and supporting those in need. POSITION PURPOSE Adobe Population Health (APH) is seeking an experienced and strategic Quality and Compliance Officer to lead the organization’s quality management, regulatory compliance, and risk mitigation efforts. This role is responsible for ensuring that APH maintains the highest standards of operational integrity, regulatory adherence, and continuous quality improvement across all programs and services. The Quality and Compliance Officer plays a critical leadership role in developing and overseeing the organization’s Quality Assessment and Performance Improvement (QAPI) program, regulatory compliance framework, accreditation readiness, and risk management initiatives. Working closely with executive leadership, clinical teams, and operational stakeholders, this position ensures that policies, procedures, and performance metrics align with federal and state regulations, payer contractual obligations, and accreditation standards, including NCQA and URAC. This leader will foster a culture of accountability, transparency, and continuous improvement by leveraging data analytics, monitoring performance indicators, and implementing quality initiatives that enhance member outcomes and operational effectiveness. The role also serves as the primary liaison for regulatory agencies, health plan partners, and accreditation bodies, ensuring the organization remains audit-ready and compliant while supporting the strategic growth and credibility of APH. This position is based in our Phoenix office (16th St. & Glendale Ave.), conveniently located off the SR-51 freeway. The role operates in a hybrid schedule, with three days in-office and two days remote, Monday through Friday, 8:00 AM – 5:00 PM. DUTIES & RESPONSIBILITIES Quality Management & Performance ImprovementDesign, implement, and oversee the organization’s Quality Management System to ensure consistent adherence to quality standards across all programs and operations. Lead the Quality Assessment and Performance Improvement (QAPI) Program, ensuring performance metrics and initiatives meaningfully support operational excellence and improved member outcomes. Establish and monitor quality objectives, key performance indicators, and outcome metrics in collaboration with cross-functional leadership. Facilitate quality improvement initiatives that incorporate evidence-based practices and support continuous improvement across care delivery and operational workflows. Regulatory & Accreditation ComplianceMaintain comprehensive knowledge of applicable federal, state, and contractual regulatory requirements, including CMS, OSHA, OIG, and state health agencies. Ensure ongoing compliance with NCQA and URAC accreditation standards, including preparation for surveys, documentation reviews, and performance measure submissions. Identify opportunities for additional certifications or accreditations that enhance the organization’s credibility and operational excellence. Maintain regulatory monitoring systems to track updates and ensure organizational policies and procedures remain compliant. Compliance Program OversightProvide leadership and oversight of the organization’s Compliance Program, ensuring clear communication of compliance expectations and regulatory obligations across the organization. Coordinate compliance reporting to health plan partners in accordance with contractual obligations, including quarterly reporting and event-based notifications. Participate in Joint Operating Committee (JOC) meetings with health plan partners and represent APH’s commitment to regulatory and contractual compliance. Audit & Regulatory ReadinessLead internal and external audits to assess operational effectiveness, regulatory compliance, and adherence to contractual requirements. Serve as the primary organizational contact for health plan and regulatory audits, managing the audit lifecycle from notification through successful completion. Prepare and coordinate documentation required for pre-delegation reviews, annual compliance audits, and accreditation assessments. Ensure corrective action plans are developed and implemented for identified compliance or performance gaps. Risk Management & Emergency PreparednessIdentify, assess, and mitigate operational and regulatory risks affecting the organization, employees, members, and partners. Oversee the Emergency Response and Disaster Preparedness Program across all states in which APH operates. Ensure compliance with OSHA standards and workplace safety requirements across all operational locations. Quality Improvement & Clinical Program OversightSupport the evaluation and implementation of evidence-based clinical practices across care management programs. Conduct annual reviews of clinical guidelines and program descriptions to ensure alignment with regulatory and accreditation requirements. Collaborate with clinical leadership to strengthen quality outcomes and improve program effectiveness. Data Analysis & Performance ReportingUtilize data analytics to monitor organizational performance indicators and identify trends that inform strategic decision-making. Prepare reports and performance summaries for executive leadership, governing boards, and regulatory entities. Coordinate data reporting and performance measure submissions required for NCQA and URAC accreditation. Policy & Procedure GovernanceOversee the annual review and maintenance of organizational policies, procedures, standard operating procedures (SOPs), and clinical pathways. Ensure documentation reflects current best practices and regulatory requirements and is effectively communicated and implemented across the organization. Manage the organization’s policy management platform, ensuring staff have appropriate access to policies and governance materials. Member Complaint & Grievance OversightOversee the organization’s member grievance and complaint process, ensuring timely acknowledgment, investigation, and resolution. Ensure compliance with required response timelines, including acknowledgment within 10 days and resolution within 30 days. Partner with leadership to identify systemic issues and implement improvements that enhance member satisfaction and service quality. Staff Development & Organizational EducationPartner with training and leadership teams to develop and deliver education programs related to quality assurance, regulatory compliance, and risk management. Promote a culture of continuous learning and compliance awareness across the organization. Leadership & Organizational CollaborationSupervise and mentor members of the Quality and Compliance team, providing guidance, accountability, and professional development support. Foster collaboration across departments to strengthen quality initiatives and compliance adherence organization wide. Maintain effective communication with clinical staff, executive leadership, regulatory bodies, and external partners. Compliance & PrivacyEnsure adherence to HIPAA privacy and security regulations, including employee education, monitoring, and enforcement of data protection policies. Additional Responsibilities This job description is intended to outline the primary responsibilities of the role but is not exhaustive. The Quality and Compliance Officer may be asked to perform additional duties consistent with their scope of expertise and organizational needs. SKILLS & QUALIFICATIONSA minimum of two (2) years of experience in healthcare quality management, compliance, or a similar leadership role. In-depth knowledge of healthcare regulations, accreditation standards, and quality improvement methodologies. Experience leading and managing teams, with strong leadership, coaching, and mentoring skills. Excellent analytical and problem-solving abilities, with a keen eye for detail. Strong interpersonal and communication skills, capable of interacting with individuals at all levels of the organization. Proven track record of implementing successful quality improvement initiatives and driving organizational change. Familiarity with healthcare IT systems and data analysis tools. EDUCATION, LICENSES, & CERTIFICATIONSBachelor’s degree in healthcare administration, nursing, medicine or a related field is required. Relevant professional work experience may be considered in lieu of a degree. Certified in relevant quality management or compliance-related certifications (e.g., Certified Professional in Healthcare Quality - CPHQ, Certified in Healthcare Compliance - CHC) is a plus. BENEFITS & TOTAL REWARDS Paid Orientation and Training Insurance – Medical, Dental, Vision, and Life401k Plan – 3% matchEmployee Assistance ProgramTuition ReimbursementContinued Education SupportMileage Reimbursement (if applicable)Referral BonusesPaid Holidays (8 days)Paid Time Off (15 days)Paid Volunteer Hours CHARACTER & COMPETENCIESCourage – To have the courage to the right thing at the right time.Ownership – To take ownership of every issue you touch.Respect – To respect yourself, co-workers, and for those whom you care.Excellence – To be excellent in all that you do.Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethics; Upholds organizational values.Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.Judgement - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.Problem-Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem-solving situations; Uses reason even when dealing with emotional topics.Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed. PHYSICAL DEMANDS & WORK ENVIRONMENT Occasionally required to stand.Occasionally required to walk.Continually required to sit.Occasionally required to climb, balance, bend, stoop, kneel, or crawl.Continually required to talk or hear.While performing the duties of this job, the noise level in the work environment is usually moderate.May occasionally lift and /or move more than 30 pounds.Must be able to physically perform the essential duties of the position which include lifting 30 lbs., transporting materials, stooping, kneeling, crouching, reaching, use of hands, balancing, walking, standing, talking, hearing, and typing. EQUAL EMPLOYMENT OPPORTUNITY APH is an Equal Opportunity Employer where all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.