Quality Assurance Administrator

About Our Client:

The organization operates within the healthcare and social services sector, focusing on supporting individuals at risk and those with complex care needs. It addresses the challenge of enabling individuals to remain in the least restrictive environment of their choice while improving quality of life through coordinated, person-centered services and supports. The organization aims to transform individuals’ lives and provide families with assurance that their loved ones have a voice and valued role in their community. This position is remote in Vermont.

About the Opportunity:

The QUALITY ASSURANCE ADMINISTRATOR role is responsible for supporting quality assurance oversight of Case Management services. The position ensures compliance with Medicaid requirements, state regulations, accreditation standards, contractual obligations, and organizational quality expectations. It contributes to strengthening service delivery, improving outcomes, and maintaining readiness for audits by conducting reviews, analyzing data, monitoring corrective actions, identifying quality trends and risks, and supporting continuous quality improvement initiatives. This role collaborates closely with leadership and frontline teams but does not manage frontline operations or corporate compliance.

Responsibilities:

• Administer and support Quality Assurance and Continuous Quality Improvement programs for care coordination services.
• Conduct quality reviews of support plans, case records, and documentation for completeness, appropriateness, accuracy, and compliance.
• Coach Field Care Coordinators and advise supervisors on documentation quality and compliance.
• Submit finalized support plans to state agencies as required.
• Monitor compliance with contractual deliverables, timelines, documentation standards, policies, procedures, and regulations.
• Provide second-line quality assurance oversight and escalate issues as needed.
• Communicate findings, deficiencies, risks, and recommendations to leadership for corrective action.
• Analyze various data sources to identify trends, risks, training needs, and improvement opportunities.
• Prepare reports, dashboards, and regulatory submissions.
• Support audits, monitoring activities, and documentation collection to demonstrate quality and compliance.
• Collaborate with leadership and training staff on root cause analysis and corrective actions.
• Conduct follow-up reviews to verify corrective actions’ effectiveness.
• Escalate significant or recurring quality and compliance concerns through governance channels.
• Engage with participants, families, and guardians regarding quality concerns and complaint processes.
• Ensure participant awareness of complaint and grievance procedures and incorporate feedback into improvements.
• Participate in developing and monitoring quality assurance and CQI processes.
• Maintain documentation supporting regulatory, contractual, and organizational requirements.
• Complete required training and support audit and accreditation readiness.

Requirements:

• Bachelor’s degree in Human Services, Behavioral Sciences, Social Sciences, or related field, or four years of relevant experience.
• Minimum three years of experience in quality assurance, auditing, or quality improvement within healthcare, Medicaid, HCBS, or developmental disabilities services.
• Preferred experience in case management or developmental disabilities services.
• Knowledge of Medicaid, HCBS, and state policies and regulations.
• Strong analytical skills with experience in trend identification and report development.
• Experience with corrective action and quality improvement plans.
• Proficiency in Microsoft Office 365 and electronic record systems.
• Excellent written and verbal communication skills.
• Strong attention to detail and ability to work independently.
• Professional engagement with participants, families, and multidisciplinary teams.
• Strong organizational and time management skills.

Pay Range and Compensation Package:

• The pay range and compensation package for this role will be determined based on the candidate's experience, skills, and other relevant factors.

Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.

Note:

RemoteHunter is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.