Position Summary
The Quality Compliance Manager serves as a key partner to operational and clinical leadership, ensuring compliance with federal, state, payer, and company standards. This role is responsible for conducting audits, identifying compliance risks, developing sustainable quality assurance processes, and helping drive accountability across multiple agencies.
The ideal candidate is an experienced Registered Nurse with a strong understanding of Home Health regulations, OASIS, Medicare and Medicaid compliance, post-payment reviews, and quality improvement methodologies. This individual must be comfortable working independently, providing constructive feedback to leaders, and building collaborative relationships across a multi-state organization.
Essential Duties & Responsibilities
Compliance & Quality Assurance
- Conduct periodic Home Health and Home Care audits based on regulatory and payer requirements.
- Perform documentation reviews to identify compliance risks, process gaps, and opportunities for improvement.
- Assist in the development and implementation of post-payment audit processes and ADR review workflows.
- Compile audit findings and prepare reports for operational and executive leadership.
- Monitor corrective action plans and follow-up activities to ensure compliance improvements are sustained.
- Maintain and update CMS filings and regulatory reporting requirements as needed.
- Support survey readiness efforts and ongoing compliance initiatives.
Process Improvement
- Develop and refine quality assurance processes, audit tools, reporting structures, and compliance workflows.
- Analyze trends and identify opportunities to improve operational and clinical performance.
- Partner with agency leaders to establish accountability and drive compliance initiatives.
- Assist with policy and procedure review, revision, and implementation.
Leadership & Collaboration
- Educate agency leaders on regulatory requirements, audit findings, and best practices.
- Provide constructive feedback and coaching to operational and clinical leaders.
- Collaborate across Operations, Clinical, Revenue Cycle, and Executive Leadership teams.
- Serve as a trusted resource for compliance-related questions and process improvement opportunities.
Required Qualifications
- Active Registered Nurse (RN) license in good standing.
- Minimum 3-5 years of Home Health experience required.
- Strong knowledge of Medicare Conditions of Participation and Medicaid regulations.
- OASIS experience required.
- Experience conducting clinical audits, quality assurance reviews, compliance monitoring, or survey readiness activities.
- Foundational understanding of home health billing, reimbursement processes, ADRs, denials, and post-payment reviews.
- Experience working within multiple EMR systems.
- Strong Microsoft Excel skills.
- Excellent organizational, analytical, and problem-solving abilities.
- Strong written and verbal communication skills.
- Ability to work independently with minimal supervision.
- Ability to travel up to 25%.
Preferred Qualifications
- BSN preferred.
- Experience supporting both Home Health and Home Care operations.
- Multi-state compliance experience, particularly in Indiana and Illinois.
- Experience developing quality assurance programs, audit processes, or compliance workflows.
Experience influencing and driving accountability among leaders who are not direct reports.
Qualifications
Are you searching for aPurpose? PurposeCare is Bringing Healthcare Home, and we want you to join our family
PurposeCareis a leading provider of home care and home health services in the Midwest and provides home-based care services to more than 3,000 clients a month carefully coordinated to keep clients healthy and safe at home. With excellent caregivers and innovative technology, PurposeCare ensures that our most vulnerable are provided with the support necessary to live full lives in their community. Your Care is Our Purpose.
As a growing company we provide:
- A rewarding career making a difference, changing lives & communities
- Schedule Flexibility
- Ongoing growth, training & professional development
- Mentor, on-call & referral programs
- Opportunity to apply for positions at our otherPurposeCare locations
