Director of Compliance and Quality Improvement

As the Director of Compliance and Quality Improvement you will be responsible for overseeing and ensuring regulatory compliance, quality assurance, and program improvement within the company. This role involves the management of documentation, audits, service tracking, training, and policy development to enhance service delivery and uphold the organization's mission.

Regulatory Compliance

• Maintains organizational compliance with Iowa Administrative Code Chapter 441, the federal HCBS Settings Rule, HIPAA, Medicaid documentation requirements, and Managed Care Organization contract terms.
• Monitors regulatory changes including Iowa HHS informational letters, fee schedule revisions, and service code changes — and assesses and communicates operational impact.
• Serves as the organizational point of contact for external reviews by Iowa HHS, DIAL, and MCOs, and coordinates responses and corrective action.
• Oversees critical incident reporting and mandatory dependent adult abuse reporting for completeness and timeliness.
• Maintains the policy and procedure library, including development, revision cycle, version control, and approval routing.

Accreditation

• Serves as the liaison to the Council on Quality and Leadership and manages the accreditation cycle, including submissions, plans of action, reviewer correspondence, and on-site visits.
• Maintains the Basic Assurances monitoring plan and produces required monitoring summaries.
• Owns the Personal Outcome Measures system, including interviewer capacity and training, scheduling, aggregate review, and application of results in organizational planning.

Quality Improvement

• Develops and executes quality improvement plans aligned with organizational goals, including defined indicators and targets.
• Collects and reviews quality and compliance data on a regular cycle to identify trends, root causes, and improvement opportunities.
• Oversees quality improvement projects, including scope, timeline, and implementation, within established timelines.
• Collaborates with department leaders to identify quality concerns and develop solutions.

Member Rights

• Convenes and chairs the Human Rights Committee, including agenda, materials, and minutes.
• Maintains the rights restriction register and ensures HRC review of each new restriction and annual re-review of all restrictions.
• Gathers grievance data, analyzes trends, and reports findings to the Human Rights Committee and leadership.

Member Records and Benefits Systems

• Establishes and maintains the systems, procedures, and tracking methods by which member benefits are applied for, renewed, and documented.
• Establishes and maintains the systems by which member records are kept current and compliant, including service authorizations, Notices of Decision, annual service agreements, and releases of information.
• Administers the electronic health record for compliance purposes, including configuration, user roles, report development, and data integrity.

Audit and Support to Programs

• Conducts scheduled and ad hoc audits of member records, service documentation, and program files, and reports findings to responsible positions for correction.
• Provides practical support to program and billing staff on documentation completeness and service delivery verification.

Must possess a bachelor’s degree or higher in healthcare administration, social services, or a related field of study or an equivalent combination of education and directly related experience.  Additional requirements include:

• Basic understanding of data analysis techniques, statistical methods, and data visualization tools to interpret data sets.
• Proven experience in leading and motivating teams to achieve quality improvement goals within a home and community-based services or social services setting.
• Excellent written and verbal communication skills to effectively convey complex information to diverse audiences.
• Demonstrated ability to write policy and procedures that withstand external review.
• Working knowledge of Iowa HCBS waiver services including Supported Community Living (SCL) and adult day care.
• Proficiency with electronic health record systems and the ability to administer & configure records for compliance purposes.  Experience with Therap is a plus.
• Basic knowledge of the HIPAA Privacy and Security rules.
• Familiarity with a recognized quality framework; CQL Basic Assurances and Personal Outcome Measures preferred.