Quality and Compliance Manager

Position Title: Quality and Compliance Manager

Department: Compliance

Reports To: VP of Quality and Compliance

Location: California (Hybrid)

Employment Type: Full-time Exempt

Travel Requirement: 20%

About MedZed

MedZed is a leader in delivering value-based, technology-enabled social support to high-cost Medicaid members who are unreachable and disconnected from their primary care provider. We combine innovative outreach and care models with technology to find and engage members, connect them to primary care, and improve outcomes. Our intervention yields reduced costs and assists our members in enhancing their quality of life.

Position Overview

The Quality & Compliance Manager is responsible for designing, implementing, and monitoring the organization's compliance and regulatory risk control frameworks across in-home healthcare operations. Reporting directly to the VP of Quality & Compliance, this role serves as a central resource for ensuring that MedZed's programs, contracts, and internal processes adhere to federal and California state regulatory requirements — including Medi-Cal, IHSS, CBAS, and applicable managed care contract obligations.

Key Responsibilities

• Compliance Monitoring & Regulatory Risk: Design and maintain a regulatory compliance monitoring calendar covering DHCS, DMHC, CMS, and applicable county contract requirements. Conduct ongoing monitoring of federal and California regulatory changes; assess operational impact and drive timely policy updates.
• Internal Compliance Controls: Build and maintain an internal compliance controls library, including policies, procedures, attestations, and audit tools. Conduct routine internal audits and testing across clinical operations, billing, documentation, and vendor management.
• Contract Risk Management: Review and assess new and renewing contracts for compliance risk, including payer agreements, subcontractor arrangements, and vendor contracts.
• Training & Culture: Develop and deliver compliance training for Community Health Navigators (CHNs) and program staff, including annual and role-specific curricula.
• Reporting & Documentation: Prepare compliance reports, board updates, and regulatory submissions as directed by the VP.

Qualifications

Required Experience: 3+ years of direct experience in compliance monitoring, regulatory risk controls, and contract risk management in a healthcare setting.

Education: Bachelor’s degree in healthcare administration, Public Health, Business Administration, or a related field required.

Physical Requirements

This position requires the employee to remain in a stationary position for prolonged periods while performing desk-based computer tasks.

Work environment & Conditions

This is a hybrid position based in California. The Quality and Compliance Manager is expected to be available for periodic on-site visits to operational locations, county meetings, and regulatory site visits.