Quality Manager – Remote in NJ

Abound Health; United States; Remote; USD 60,000 - 65,000; Full time

Benefits offered by this job

Health insurance

Dental coverage

Wellness program

401(k) eligibility

Job summary

Abound Health is seeking a Quality Manager to lead the day-to-day execution of quality, regulatory, payer, and contract compliance programs across New Jersey operations. This remote role will coordinate with clinical, finance, billing, HR and legal teams to ensure state and federal compliance, payer policies, and contractual obligations.

Reporting to the EVP of Quality & Compliance, you will guide NJ-specific priorities, monitor audits, and drive corrective actions while embedding quality into

Qualifications

• Bachelor's degree in Healthcare Administration, Business, Nursing, Social Work, Public Health, Quality/Compliance or related field.
• 5 years of progressive experience in healthcare quality/compliance.
• Direct experience with payer requirements, contract compliance and incident reporting in a regulated environment.
• Experience in behavioral health/IDD/HCBS or similar setting preferred.
• Knowledge of NJ DDD Medicaid Waiver or NJ FamilyCare requirements strongly preferred.

Responsibilities

• Lead New Jersey quality and compliance priorities and workplans.
• Serve as NJ subject matter lead for quality, compliance, contract requirements and payer expectations.
• Embed quality and compliance into daily operations, onboarding and service delivery.
• Maintain knowledge of NJ DDD requirements and translate into workflows and training.
• Oversee payer audit preparation and responses including medical record requests and reviews.
• Identify and resolve potential overpayments.
• Oversee NJ incident management, investigations, and root cause analysis.
• Develop and monitor Plans of Correction after investigations.
• Coordinate accreditation and external reviews as applicable.
• Design and execute NJ audit and monitoring plans across documentation and billing support.
• Establish and monitor quality dashboards and KPIs.
• Provide routine reporting to leadership and flag material risks.

Skills

Communication

Collaboration

Project management

Analytical skills

Education

Bachelor's degree in Healthcare Administration

Master's degree preferred

Job description

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 Responsibilities

• Lead New Jersey specific quality and compliance priorities workplans and operating processes
• Serve as the New Jersey subject matter lead for quality compliance contract requirements and payer expectations
• Partner with operations and clinical teams to embed quality and compliance into daily operations onboarding supervision and service delivery
• Maintain knowledge of New Jersey DDD requirements and documentation standards and translate requirements into workflows and training
• Partner with billing and finance to monitor claims quality denials recoupments and audit activity and drive corrective actions
• Oversee payer audit preparation and responses including medical record requests and pre and post payment reviews
• Support the identification documentation and resolution of potential overpayments
• Oversee the New Jersey incident management process including timely reporting and tracking of reportable incidents
• Lead or support investigations and root cause analysis for incidents complaints and grievances
• Develop and monitor Plans of Correction following investigations
• Coordinate accreditation and external reviews as applicable
• Design and execute New Jersey audit and monitoring plans covering documentation authorizations contract deliverables incidents credentials and billing support
• Establish and monitor quality and compliance dashboards and KPIs
• Provide routine reporting to leadership and escape material risks and trends
• Represent quality and compliance in New Jersey payer DDD and contract partner interactions as requested

Qualifications

• Bachelors degree in Healthcare Administration Business Nursing Social Work Public Health Quality Compliance or a related field; Masters degree preferred
• 5 years of progressive experience in healthcare qualitycompliance
• Direct experience with payer requirements contract compliance and incident reporting in a regulated environment
• Experience in behavioral health IDD HCBS or a similar setting preferred
• Experience with New Jersey DDD Medicaid Waiver or NJ FamilyCare requirements strongly preferred
• Knowledge of compliance programs auditingmonitoring credentialing corrective action and training programs
• Working knowledge of New Jersey incident reporting requirements background checkCARI processes and mandatory reporting laws
• Ability to interpret contracts payer manuals and regulations and translate them into practical operational processes
• Strong communication collaboration project management and analytical skills
• Ability to influence and collaborate effectively across teams

Compensation & Benefits

• The 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
• 401k eligibility after 12 months

Equal Employment Opportunity

Abound 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