Quality Assurance Administrator

COLUMBUS MEDICAL SERVICES LLC; Wilmington (VT); Remote; USD 60,000 - 90,000; Full time

Job summary

The Columbus Organization is seeking a Quality Assurance Administrator to support QA oversight for Case Management services. This remote Vermont-based role focuses on compliance with Medicaid requirements, state regulations, and accreditation standards, while driving continuous quality improvement.

Key duties include conducting reviews, analyzing data, coaching staff, preparing reports, and ensuring audit readiness.

Qualifications

• Bachelor’s degree or four or more years of related experience.
• Experience in quality assurance, auditing, or quality improvement in healthcare settings is required.
• Knowledge of Medicaid, HCBS, and state policies is essential.

Responsibilities

• Administer QA/CQI program for care coordination services.
• Conduct quality reviews of plans, records, and documentation for compliance.
• Coach field staff and provide guidance on documentation quality and corrective actions.
• Submit finalized plans to state agencies when applicable.
• Monitor contract deliverables, timelines, and regulatory requirements.
• Prepare QA reports, dashboards, and regulatory submissions.
• Identify trends and recommend improvements based on data analyses.

Skills

Medicaid/HCBS policies

Analytical skills

Quality improvement planning

Documentation accuracy

Communication skills

Independent work

Team collaboration

Project coordination

Education

Bachelor’s degree in Human Services/related field

Tools

Microsoft Office 365

Electronic record systems

Job description

Location

Position Location

This position is remote in Vermont.

About Us

The Columbus Organization is a group of caring professionals whose mission is to assist individuals at risk and with complex care needs remain in the least restrictive environment of their choice while improving their quality of life through coordinated services and supports. With a person-centered planning & thinking approach, it is our vision to be recognized as an organization that transforms individuals’ lives and provides families the peace of mind in knowing their loved one has a voice and a valued role in their community.

Summary of position

The Quality Assurance Administrator supports quality assurance oversight for Case Management services by monitoring compliance with Medicaid requirements, state regulations, accreditation standards, contractual obligations, and organizational quality expectations. This role conducts record reviews, analyzes performance data, monitors corrective actions, identifies quality trends and risks, and supports continuous quality improvement initiatives. Working closely with program leadership, supervisors, Quality, Compliance, Training, and frontline teams, the position helps strengthen service delivery, improve outcomes, and maintain audit readiness. This role focuses on quality assurance and performance monitoring and does not oversee frontline case management operations or corporate compliance functions, which remain under the direction of the VP, Corporate Compliance.

Essential Functions

1. Administer and support the Quality Assurance (QA) and Continuous Quality Improvement (CQI) program for care coordination services.
2. Conduct quality reviews of support plans, case records, and related documentation to ensure completeness, clinical appropriateness, accuracy, and compliance with organizational, contractual, state, and federal requirements.
3. Coach Field Care Coordinators and provide guidance to supervisors on documentation quality, compliance expectations, and corrective actions.
4. Submit finalized support plans to state agencies, as applicable.
5. Monitor compliance with contractual deliverables, service timelines, documentation standards, policies, procedures, and regulatory requirements.
6. Monitor the timeliness, completeness, and quality of required plan submissions and provide second-line quality assurance oversight and escalation as needed.
7. Communicate quality review findings, documentation deficiencies, risks, and recommendations to leadership to support corrective action and performance improvement. (VT req.)
8. Analyze quality, performance, complaint, grievance, incident, satisfaction, and audit data to identify trends, risks, training needs, and opportunities for improvement.
9. Prepare quality assurance reports, dashboards, and regulatory submissions for leadership and external stakeholders, as required.
10. Support audits, record reviews, monitoring activities, and the collection of documentation required to demonstrate quality performance and contractual compliance.
11. Partner with leadership, supervisors, and training staff to identify root causes, implement corrective actions, and evaluate the effectiveness of quality improvement initiatives.
12. Conduct follow-up reviews and monitoring activities to verify corrective actions are implemented, sustained, and effective. (VT req.)
13. Escalate significant or recurring quality and compliance concerns through established governance channels, including referral to Compliance when appropriate. (VT req.)
14. Engage with participants, families, and guardians, as appropriate, to address quality concerns, promote participant rights, support resolution efforts, and improve satisfaction outcomes.
15. Ensure participants are informed of complaint and grievance procedures and that feedback is incorporated into quality improvement activities.
16. Participate in the development, implementation, annual review, and ongoing monitoring of quality assurance and CQI processes. (VT req.)
17. Maintain governance-ready quality documentation, corrective action records, audit evidence, and leadership reporting to support regulatory, contractual, and organizational requirements. (VT req.)
18. Complete required training and support organizational readiness for audits, accreditation reviews, and quality monitoring activities.

Position Requirements

1. Bachelor’s degree from an accredited institution in Human Services, Behavioral Sciences, Social Sciences, or a related field. In lieu of a degree, four (4) or more years of experience in a relevant field may be considered.
2. Minimum of three (3) years of experience in quality assurance, auditing, or quality improvement within healthcare, Medicaid, HCBS, or developmental disabilities services.
3. Experience in case management or developmental disabilities services strongly preferred.
4. (Education or experience requirements may be waived where permitted by states based on demonstrated capability.)

Skills, Knowledge & Abilities

1. Knowledge of Medicaid, HCBS, and state policies and regulations.
2. Strong analytical skills with the ability to identify trends and develop clear reports.
3. Experience developing and monitoring corrective action and quality improvement plans.
4. Proficiency in Microsoft Office 365 and electronic record systems.
5. Excellent written and verbal communication skills.
6. Strong attention to detail, accountability, and ability to work independently.
7. Ability to engage professionally with participants, families, and multidisciplinary teams.
8. Strong organizational skills with the ability to prioritize and meet deadlines.

Travel/Work Environment

• Occasional evening or weekend work may be required based on program needs.
• Remote position in Vermont.

The job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time.

AAP/EEO Statement

The Columbus Organization provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, The Columbus Organization complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

The Columbus Organization expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of The Columbus Organization’s employees to perform their job duties may result in discipline up to and including discharge.

Monday-Friday, 8:00 AM - 5:00 PM