Director of Payer Compliance & Quality Assurance

Salary: $120,000 - $130,000 as year (DOE)

On-Site Position

The Director of Payer Compliance & Quality Assurance is a senior leadership role responsible for strengthening organizational compliance, quality, and revenue integrity across all levels of care, including PHP, IOP, OP, Residential, and Adolescent Services.

This role provides strategic oversight and hands‑on leadership in the development, implementation, and continuous monitoring of payer‑specific compliance frameworks, ensuring alignment with state regulations, accreditation standards (Joint Commission, CARF), and payer medical necessity requirements.

Responsibilities

• Lead organization‑wide payer compliance strategy across all levels of care (PHP, IOP, OP, Residential—Adult & Adolescent)
• Interpret payer policies, medical necessity criteria, state regulations, and accreditation standards (Joint Commission, CARF)
• Develop and maintain payer compliance crosswalks aligned to payer, regulatory, and accreditation requirements
• Design and oversee a company‑wide QA and payer compliance audit program
• Audit clinical documentation, utilization review records, and medical necessity support to ensure payer readiness
• Track, trend, and analyze audit findings to identify risks, gaps, and performance opportunities
• Build dashboards and scorecards monitoring compliance rates, documentation quality, and denial trends
• Lead performance improvement initiatives and corrective action plans in collaboration with leadership
• Develop and deliver compliance training, tools, and workflows for clinical, medical, and operations teams
• Serve as subject matter expert for payer audits, accreditation surveys, state inspections, and denials prevention efforts
  
  
  

Qualifications

• Master’s degree in Behavioral Health, Healthcare Administration, Nursing, or a related field preferred
• Independent clinical licensure strongly preferred (e.g., LMHC, LCSW, LPC, RN )
• 5–7 years of progressive experience in:

• Behavioral health compliance
• Quality assurance or utilization review
• Payer or revenue integrity oversight
  
  
  
  

• Advanced knowledge of:
• LOCUS criteria and payer medical necessity standards
• Joint Commission and/or CARF accreditation requirements
• State and multi‑state regulatory frameworks
  
  
  

Benefits

• Access to professional growth using our cutting-edge strategies and trainings with our exceptional leaders.
• Medical, Dental & Vision Insurance – Multiple plan options including PPO and HDHPs with HSA eligibility and company contributions.
• Paid Parental Leave – Up to 6 weeks fully paid for exempt employees and 4 weeks for non-exempt.
• Life & Disability Coverage – Company-paid life, AD&D, and long-term disability; voluntary life and optional short-term disability available.
• 401(k) with Company Match – Retirement savings with matching contributions after eligibility period.
• PTO & Holidays – Competitive PTO accrual plans and paid holidays throughout the year.
• Employee Assistance Program (EAP) – Free, confidential support for life’s challenges.
  
  
  

Embark is an Equal Employment Opportunity Employer. We are committed to enriching the therapeutic and healing experience we offer through the diversity of our employees and community. We actively seek to recruit and support a broadly diverse staff who contribute to our excellence, diversity of viewpoints and experiences, and relevance in a global society.

Embark does not discriminate on the basis of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, marital status, veteran status, or any other protected status under applicable laws. Accommodations are available for applicants with disabilities.