Remote Clinical Quality & Compliance Program Lead

Wellsky; United States; Remote; USD 90,000 - 130,000; Full time

Benefits offered by this job

Excellent medical with Rx, dental, and

Mental Health support through EAP

Paid time off and holidays

100% vested 401(K) retirement plans

Educational assistance

Job summary

WellSky is seeking a compliance and quality improvement professional to ensure adherence to CMS and NCQA standards across post-acute settings. The role analyzes data, leads improvement initiatives, and prepares detailed reports for leadership.

You will facilitate performance measurement, coordinate audits, and support remediation plans while maintaining strong regulatory knowledge and collaboration with cross-functional teams. This is a remote position with occasional travel.

Qualifications

• 4–6 years relevant work experience.
• Experience leading quality improvement projects and committee work.
• Bachelor's Degree or equivalent work experience.

Responsibilities

• Facilitate performance measurement and outcomes against CMS/NCQA standards.
• Generate and validate reports for health plan contracts.
• Audit UM decisions, case documentation, and turnaround times.
• Align UM program with NCQA requirements for accreditation.
• Lead monthly and quarterly committee meetings.
• Prepare quality reports and present findings with actionable recommendations.
• Support corrective action plans and quality improvement initiatives.
• Prepare for regulatory and contractual audits.

Skills

Quality improvement

Data analysis

Regulatory compliance

Education

Bachelor's degree

Tools

CMS standards

NCQA UM accreditation

Job description

WellSky is seeking a compliance and quality improvement professional to ensure adherence to CMS and NCQA standards across post-acute settings. The role analyzes data, leads improvement initiatives, and prepares detailed reports for leadership.

You will facilitate performance measurement, coordinate audits, and support remediation plans while maintaining strong regulatory knowledge and collaboration with cross-functional teams. This is a remote position with occasional travel.