Home Care Compliance and Quality Manager

Alana-Home-Care; Franklin (TN); On-site; USD 90,000 - 120,000; Full time

Job summary

Alana Home Care in Franklin, Tennessee seeks a Home Care Compliance and Quality Manager to lead compliance, quality assurance and incident management, conducting investigations, audits and corrective actions. You will translate regulatory requirements into practical policies and collaborate with leaders across scheduling, recruiting, billing and operations to reduce risk and improve care.

This hands-on management role requires strong documentation, independent judgment and the ability to travel

Qualifications

• Minimum two years of experience in home care, home health, Medicaid services, quality assurance, compliance, risk management or clinical supervision.
• Demonstrated experience conducting investigations, audits or clinical record reviews.
• Strong knowledge of documentation standards, client safety and healthcare regulatory requirements.
• Ability to interpret regulations and contracts and convert them into understandable operational procedures.
• Excellent written communication and investigative documentation skills.
• Strong interviewing, critical-thinking and problem-solving abilities.
• Ability to handle confidential and sensitive information with discretion.
• Proficiency with Microsoft Office and electronic healthcare, scheduling or compliance systems.
• Valid driver’s license and ability to travel within Tennessee as needed.

Responsibilities

• Lead or coordinate investigations involving client complaints, caregiver conduct, service delivery concerns, injuries, hospitalizations, medication issues and suspected abuse, neglect or exploitation.
• Complete timely, impartial and well-documented investigations.
• Conduct interviews with clients, caregivers, employees and other involved parties.
• Determine whether allegations are substantiated and identify required follow-up actions.
• Ensure critical incidents are reported to TennCare, MCOs, Veterans Affairs, Adult Protective Services or other agencies within applicable deadlines.
• Monitor incident trends and recommend preventive actions.
• Maintain organized and confidential investigation records.
• Escalate significant clinical, legal or regulatory risks to executive leadership promptly.
• Monitor compliance with Tennessee home care regulations and applicable TennCare, MCO, ECF CHOICES, CHOICES and Veterans Affairs requirements.
• Maintain a current understanding of changing regulatory and contractual obligations.
• Translate requirements into practical policies, procedures, workflows and employee guidance.
• Support regulatory, payer and contractual audits, including document preparation and responses to findings.
• Coordinate plans of correction and verify that corrective actions are completed and sustained.
• Monitor compliance with background checks, registry checks, drug-screening requirements, training, licenses, certifications and other caregiver qualifications.
• Provide compliance guidance to scheduling, recruiting, human resources, intake, billing and operational leadership.
• Promote a culture in which employees report concerns promptly and without fear of retaliation.
• Develop and maintain a formal quality-assurance and performance-improvement program.
• Perform routine audits of client records, caregiver files, service documentation, care plans and operational processes.
• Monitor Electronic Visit Verification compliance, missed or late visits, manual adjustments and documentation exceptions.
• Analyze complaints, incidents, service gaps, hospitalizations, caregiver performance and audit findings to identify trends.
• Establish quality and compliance performance measures and provide regular reports to leadership.
• Recommend process improvements that enhance client safety, service initiation, reliability and caregiver performance.
• Conduct follow-up audits to determine whether corrective actions have produced lasting improvement.
• Facilitate periodic quality and compliance meetings with operational leadership.

Skills

Investigations

Audits

Documentation

Regulatory interpretation

Written communication

Interviewing

Confidentiality

MS Office

Travel readiness

Education

Bachelor of Science in Nursing

Tools

Electronic Visit Verification

WellSky Personal Care

Microsoft Office

Job description

Position:Home Care Compliance and Quality Manager

Location: Franklin, TN

Job Id:283

# of Openings:1

Position Summary

The Home Care Compliance and Quality Manager is responsible for leading Alana Home Care’s compliance, quality-assurance and incident-management activities. This position conducts investigations, performs internal audits, monitors corrective actions and works with operational leaders to identify and reduce compliance risks.

The manager will serve as a knowledgeable resource regarding Tennessee home care requirements, TennCare and MCO contracts, Veterans Affairs requirements, Electronic Visit Verification and applicable employment and healthcare regulations. This person must be able to investigate concerns objectively, recognize patterns in operational data and turn regulatory requirements into practical processes for employees and caregivers.

This is a hands-on management position requiring sound clinical judgment, excellent documentation and the ability to work collaboratively while maintaining appropriate independence and accountability.

Primary Responsibilities

Incident and Complaint Management

• Lead or coordinate investigations involving client complaints, caregiver conduct, service delivery concerns, injuries, hospitalizations, medication issues and suspected abuse, neglect or exploitation.
• Complete timely, impartial and well-documented investigations.
• Conduct interviews with clients, caregivers, employees and other involved parties.
• Determine whether allegations are substantiated and identify required follow-up actions.
• Ensure critical incidents are reported to TennCare, MCOs, Veterans Affairs, Adult Protective Services or other agencies within applicable deadlines.
• Monitor incident trends and recommend preventive actions.
• Maintain organized and confidential investigation records.
• Escalate significant clinical, legal or regulatory risks to executive leadership promptly.

Compliance and Regulatory Oversight

• Monitor compliance with Tennessee home care regulations and applicable TennCare, MCO, ECF CHOICES, CHOICES and Veterans Affairs requirements.
• Maintain a current understanding of changing regulatory and contractual obligations.
• Translate requirements into practical policies, procedures, workflows and employee guidance.
• Support regulatory, payer and contractual audits, including document preparation and responses to findings.
• Coordinate plans of correction and verify that corrective actions are completed and sustained.
• Monitor compliance with background checks, registry checks, drug-screening requirements, training, licenses, certifications and other caregiver qualifications.
• Provide compliance guidance to scheduling, recruiting, human resources, intake, billing and operational leadership.
• Promote a culture in which employees report concerns promptly and without fear of retaliation.

Quality Assurance and Improvement

• Develop and maintain a formal quality-assurance and performance-improvement program.
• Perform routine audits of client records, caregiver files, service documentation, care plans and operational processes.
• Monitor Electronic Visit Verification compliance, missed or late visits, manual adjustments and documentation exceptions.
• Analyze complaints, incidents, service gaps, hospitalizations, caregiver performance and audit findings to identify trends.
• Establish quality and compliance performance measures and provide regular reports to leadership.
• Recommend process improvements that enhance client safety, service initiation, reliability and caregiver performance.
• Conduct follow-up audits to determine whether corrective actions have produced lasting improvement.
• Facilitate periodic quality and compliance meetings with operational leadership.

Required Qualifications

• At least two years of experience in home care, home health, long-term care, Medicaid services, quality assurance, compliance, risk management or clinical supervision.
• Demonstrated experience conducting investigations, audits or clinical record reviews.
• Strong knowledge of documentation standards, client safety and healthcare regulatory requirements.
• Ability to interpret regulations and contracts and convert them into understandable operational procedures.
• Excellent written communication and investigative documentation skills.
• Strong interviewing, critical-thinking and problem-solving abilities.
• Ability to handle confidential and sensitive information with discretion.
• Proficiency with Microsoft Office and electronic healthcare, scheduling or compliance systems.
• Valid driver’s license and ability to travel within Tennessee as needed.

Preferred Qualifications

• Bachelor of Science in Nursing.
• Experience with TennCare CHOICES, ECF CHOICES, Medicaid waiver services, Veterans Affairs or managed-care organizations.
• Experience working in a personal-care or nonmedical home care agency.
• Familiarity with Electronic Visit Verification and WellSky Personal Care.
• Experience developing corrective-action plans and responding to payer or regulatory audits.
• Certification in healthcare compliance, quality, risk management or case management.
• Experience supervising or mentoring clinical, quality or compliance employees.

Compensation and Benefits

Alana Home Care offers a competitive salary based on qualifications and relevant experience. Benefits and paid time off will be discussed during the interview process.

Alana Home Care is an equal opportunity employer. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, veteran status or any other status protected by applicable law.