Remote Quality & Compliance Lead — NC Medicaid
Noble Hearts HR Consulting Inc.
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Benefits offered by this job
Job summary
Confidential Employer in North Carolina is seeking a Quality & Compliance Specialist to lead quality assurance, regulatory compliance, utilization review, and audit readiness. This remote-first role requires monthly travel to Eastern North Carolina and offers both full-time and part-time/fractional opportunities.
The ideal candidate has NC Medicaid experience, knowledge of LME/MCOs, Tailored Plans, and DHHS requirements, and can develop practical policies and workflows while monitoring
Qualifications
- NC Medicaid behavioral health compliance experience.
- Experience with audits and corrective actions.
- Knowledge of NC Medicaid requirements and DHHS guidance.
- Ability to translate regulations into practical policies/workflows.
Responsibilities
- Lead QA/QI program and quality improvement plan.
- Prepare for Medicaid, MCO, DHHS, DHSR audits.
- Identify compliance risks and develop corrective actions.
- Monitor corrective actions to completion and report trends.
- Review service authorizations to prevent coverage gaps.
- Collaborate with billing on documentation and denials.
- Ensure compliant documentation supports billed services.
- Manage client grievances related to compliance.
- Provide leadership with regular compliance findings.
Skills
Education
Tools
Job description
Confidential Employer in North Carolina is seeking a Quality & Compliance Specialist to lead quality assurance, regulatory compliance, utilization review, and audit readiness. This remote-first role requires monthly travel to Eastern North Carolina and offers both full-time and part-time/fractional opportunities.
The ideal candidate has NC Medicaid experience, knowledge of LME/MCOs, Tailored Plans, and DHHS requirements, and can develop practical policies and workflows while monitoring
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