Quality Assurance & Compliance Manager (Pasadena)

Hillsides; Pasadena (CA); On-site; USD 71,500 - 75,000; Full time

Benefits offered by this job

13 Paid Holidays per year

Paid vacation & sick leave

401(k) with 4% match

Medical, dental, vision insurance

PSLF eligibility

Employee Assistance Program

Job summary

Hillsides in Pasadena seeks a Quality Assurance & Compliance Manager to lead contract compliance and regulatory oversight. The role ensures adherence to Title 22, Medi-Cal, COA, and licensing standards while coordinating audits with county agencies.

The ideal candidate has a Master’s in social work or psychology and CA Board of Behavioral Sciences licensure, with 5+ years in EPSDT documentation. Excellent leadership and training skills are required.

Qualifications

• Master's degree in social work, psychology, or related field.
• Licensed/registered with CA Board of Behavioral Sciences (preferred).
• 5+ years’ experience with EPSDT documentation and Short Doyle Medi-Cal.

Responsibilities

• Oversee contract compliance and program coordination with Hillsides managers/directors.
• Attend QA/compliance and county trainings; provide updates and trainings.
• Review fidelity of clinical models (assessments, treatment plans, discharge summaries) and manage CAP requests.
• Assist QA/Compliance in regulatory requirements (Title 22, COA, Medi-Cal, Licensure).
• Supervise QA Clinical Specialist and conduct chart reviews; address gaps with trainings.
• Coordinate releases, record requests, subpoenas; support compliance investigations and follow-ups.
• Collaborate with leadership to set QA protocols; coordinate audits with outside agencies.
• Ensure HIPAA compliance and maintain knowledge base on clinical documentation standards.

Skills

Quality assurance

Regulatory compliance

Contract management

Leadership

Education

Master's degree in social work or psychology

CA LBS license/Board of Behavioral Sciences

Job description

Quality Assurance & Compliance Manager (Pasadena)

Who We Are:

We are a premier provider dedicated to healing children and young adults, strengthening families, and transforming communities through quality, comprehensive services and advocacy. We envision a world in which children and young adults, families, and communities are able to heal, grow, and thrive.

Starting Salary Range: $71,500 - $75,000

What We Offer:

An outstanding benefits package and numerous opportunities for career growth and advancement within our organization!

• 13 Paid Holidays per year including Juneteenth
• Earn up to 16 days of paid vacation time, plus 50 hours of paid sick leave annually
• 401(k) with no wait period and no vesting schedule
• 401(k) matching up to 4%
• Medical insurance offering 3 HMO with Kaiser and Health Net, and also a PPO Plan
• The Difference Card- Employer-funded benefit that works alongside an employee's health insurance plan to help offset out-of-pocket costs like copays, deductibles, and coinsurance.
• Dental insurance both HMO & PPO options, with 100% employer paid for HMO employee only coverage plan
• Vision insurance offers 100% employer-paid vision plan through EyeMed for you and your entire family
• Life and AD&D insurance 100% employer paid up to two times the annual salary
• Long Term Disability
• Flexible Spending Account for Medical and Dependent Care
• Employee Assistance Program
• This role is eligible for Public Service Loan Forgiveness (PSLF)

ESSENTIAL FUNCTIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.

The essential functions include:

• Oversee contract compliance (i.e. attending meetings, communicating/coordinating with Hillsides program managers/directors, training new staff, progress note/document reviews and audits, etc.)
• Responsible for tracking any contract changes regarding assigned programs such as Day Treatment Intensive (DTI)
• Attend quality assurance/compliance meetings, leadership meetings and County meetings/trainings and provide updates and trainings related to quality assurance/contract compliance as necessary
• Review and approve the fidelity of the clinical model of Hillsides governing bodies (assessments, client treatment plan, problem list, discharge summary, annual paperwork, diagnosis updates, etc.), and request/oversee Correction Action Plan (CAP) from clinical staff, including contracting psychiatrist, when fidelity is non-compliant
• Assist QA/Compliance Department in maintaining compliance with regulations regarding the governing bodies of Community Care Licensing (Title 22), Counsel on Accreditation (COA), Medi-Cal Certification, Licensure, and Accreditations
• Provide supervision to QA Clinical Specialist
• Conduct clinical chart reviews, communicate and follow up on findings, and develop staff and manager trainings where gaps are identified
• Assist and track Releases, Record Requests and Subpoenas
• Assist Chief Compliance Officer and Compliance Director in implementing compliance across the agency
• Collaborate with agency leadership in setting protocols and procedures related to quality assurance and compliance
• Interface with outside agencies to maintain current procedures, involvement in andlead coordination of audits performed by regulatory agencies
• Maintain robust knowledge base on compliance related to clinical documentation standards and their corresponding contracts. This will require active participation in clinical trainings offered within the agency or externally
• Assist with compliance investigations and agency compliance processes, including reviewing client records, participating in compliance meetings with programs, coordinating any necessary follow-up, and monitoring the overall compliance process.
• Ensure QA staff comply with the legal mandates of HIPAA regarding client confidentiality and release of information
• Participate in special projects
• Other duties as required

EDUCATION, EXPERIENCE & CERTIFICATES

• Masters degree from an accredited or state approved program degree in social work, psychology or related mental health/human services field,
• Registered with the CA Board of Behavioral Sciences in good standing required, license preferred
• Five plus years' experience with EPSDT related documentation and Short Doyle Medi-Cal
• Knowledgeable of the prevailing governmental laws and regulations regarding the provision of mental health services, including confidentiality and limits thereof, the reporting of child abuse/neglect, and related regulations
• Knowledgeable of and acts in accordance with Ethical and Professional Standards established by appropriate professional organizations, whether or not the individual is a member of any such organization

TRAUMA INFORMED CARE (TIC)

Hillsides practices Trauma Informed Care (TIC) principles which recognizes the signs, symptoms, and widespread impact of trauma; Employees are asked to comprehensively integrate knowledge of Trauma Informed Care into policies, procedures, and practices with the goal to prevent re-traumatization which promotes healing of families, youth, individuals, and communities.

Hillsides is an Equal Opportunity Employer

We welcome applicants from all backgrounds and do not discriminate based on any legally protected characteristic, including race, color, religion, sex, gender identity or expression, sexual orientation, national origin, ancestry, disability, medical condition, age, veteran or military status, or marital status, in accordance with applicable federal, state, and local laws. We are committed to providing reasonable accommodation(s) for individuals with disabilities throughout the application and employment process.