The Wilkinson Firm, LLC
Quality Assurance & Compliance Manager (Part-time/Hybrid)- Medicaid/Behavioral H
The Wilkinson Firm, LLC, Charlotte, North Carolina, United States, 28245
Quality Assurance & Compliance Manager (Part-time/Hybrid)
Job Title: Quality Assurance & Compliance Manager (Fractional) — Behavioral Health
Company: Confidential Behavioral Health Organization (Partnered with The Wilkinson Firm)
Location: Remote (with occasional travel to Eastern North Carolina)
Job Type: Contract | Part-Time | Immediate Start
About the Role A confidential behavioral health organization is seeking a
Quality Assurance & Compliance Manager
to strengthen internal QA/QI systems across multiple behavioral health programs. This part‑time, fractional leadership position focuses on maintaining compliance with Medicaid, MCO, and DHHS standards while supporting audit readiness and documentation integrity.
You’ll work directly with executive and clinical leadership to review processes, identify compliance risks, and implement quality improvement initiatives that enhance both service delivery and billing accuracy.
Key Responsibilities Quality Assurance & Improvement
Conduct routine documentation and record reviews to ensure compliance with Medicaid and state standards
Track and report on QA findings, trends, and corrective actions
Support leadership in implementing new quality improvement initiatives
Monitor staff adherence to timelines and elevate persistent issues as needed
Medicaid Authorizations & Utilization
Oversee the authorization and reauthorization process for behavioral health services
Track utilization to ensure billing accuracy and avoid service lapses
Communicate proactively with leadership on any authorization or utilization risks
Data Compliance (NC‑TOPPS & Related Systems)
Monitor NC‑TOPPS and related data submission compliance
Identify and address delayed or inaccurate submissions
Generate compliance summaries for leadership reporting
Audit Preparedness
Prepare required documentation for internal and external audits
Conduct periodic chart reviews to maintain audit‑ready status
Collaborate with clinical, billing, and administrative teams to ensure full compliance
Qualifications
Education:
Bachelor’s degree in Human Services, Healthcare Administration, Behavioral Health, or a related field (or equivalent experience)
Experience:
Minimum 3 years in behavioral health QA/QI, compliance, or utilization review
Knowledge of:
Medicaid, MCO, and DHHS compliance requirements
NCTracks, AlphaMCS, or similar authorization systems
NC‑TOPPS processes and Medicaid documentation standards
QA tracking and audit preparation in behavioral health settings
Skills:
Strong documentation and analytical review skills
Excellent communication and report writing ability
Independent problem‑solving and initiative
Ability to maintain accountability across multiple departments
Preferred
Prior experience leading QA/QI or compliance teams within a behavioral health agency
Experience responding to audits or corrective action plans
Familiarity with North Carolina Medicaid documentation standards
Role Details
Schedule:
20–25 hours per week (flexible)
Compensation:
$27–$32 per hour (commensurate with experience)
Travel:
Up to 1–2 times per month within Eastern NC for onsite audits or walkthroughs
Reporting To:
Vice President (QA/QI)
Department:
Quality Assurance / Compliance
Why This Role Matters This is a high‑impact leadership opportunity for someone who thrives on structure, accountability, and quality. As the organization expands, this role carries growth potential to evolve into full departmental leadership, overseeing future QA/QI personnel and compliance systems.
To Apply Submit your resume and a brief cover letter highlighting your experience with behavioral health QA/QI, Medicaid compliance, or audit management. Qualified candidates will be contacted for next steps.
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Company: Confidential Behavioral Health Organization (Partnered with The Wilkinson Firm)
Location: Remote (with occasional travel to Eastern North Carolina)
Job Type: Contract | Part-Time | Immediate Start
About the Role A confidential behavioral health organization is seeking a
Quality Assurance & Compliance Manager
to strengthen internal QA/QI systems across multiple behavioral health programs. This part‑time, fractional leadership position focuses on maintaining compliance with Medicaid, MCO, and DHHS standards while supporting audit readiness and documentation integrity.
You’ll work directly with executive and clinical leadership to review processes, identify compliance risks, and implement quality improvement initiatives that enhance both service delivery and billing accuracy.
Key Responsibilities Quality Assurance & Improvement
Conduct routine documentation and record reviews to ensure compliance with Medicaid and state standards
Track and report on QA findings, trends, and corrective actions
Support leadership in implementing new quality improvement initiatives
Monitor staff adherence to timelines and elevate persistent issues as needed
Medicaid Authorizations & Utilization
Oversee the authorization and reauthorization process for behavioral health services
Track utilization to ensure billing accuracy and avoid service lapses
Communicate proactively with leadership on any authorization or utilization risks
Data Compliance (NC‑TOPPS & Related Systems)
Monitor NC‑TOPPS and related data submission compliance
Identify and address delayed or inaccurate submissions
Generate compliance summaries for leadership reporting
Audit Preparedness
Prepare required documentation for internal and external audits
Conduct periodic chart reviews to maintain audit‑ready status
Collaborate with clinical, billing, and administrative teams to ensure full compliance
Qualifications
Education:
Bachelor’s degree in Human Services, Healthcare Administration, Behavioral Health, or a related field (or equivalent experience)
Experience:
Minimum 3 years in behavioral health QA/QI, compliance, or utilization review
Knowledge of:
Medicaid, MCO, and DHHS compliance requirements
NCTracks, AlphaMCS, or similar authorization systems
NC‑TOPPS processes and Medicaid documentation standards
QA tracking and audit preparation in behavioral health settings
Skills:
Strong documentation and analytical review skills
Excellent communication and report writing ability
Independent problem‑solving and initiative
Ability to maintain accountability across multiple departments
Preferred
Prior experience leading QA/QI or compliance teams within a behavioral health agency
Experience responding to audits or corrective action plans
Familiarity with North Carolina Medicaid documentation standards
Role Details
Schedule:
20–25 hours per week (flexible)
Compensation:
$27–$32 per hour (commensurate with experience)
Travel:
Up to 1–2 times per month within Eastern NC for onsite audits or walkthroughs
Reporting To:
Vice President (QA/QI)
Department:
Quality Assurance / Compliance
Why This Role Matters This is a high‑impact leadership opportunity for someone who thrives on structure, accountability, and quality. As the organization expands, this role carries growth potential to evolve into full departmental leadership, overseeing future QA/QI personnel and compliance systems.
To Apply Submit your resume and a brief cover letter highlighting your experience with behavioral health QA/QI, Medicaid compliance, or audit management. Qualified candidates will be contacted for next steps.
#J-18808-Ljbffr