Sr. Manager, Quality Assurance and Compliance
SCAN · United States
- Hybrid
- Full-time
- $181,419 / year
- United States
Job highlights
- Lead quality assurance and compliance programs.
- Enhance operational processes and member satisfaction.
- Manage quality reporting and data submission.
- Lead a team of QA and compliance professionals.
- Drive organizational goals for quality and compliance.
About the role
About SCAN
Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do.Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults.
Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.
At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.
Senior Manager, Quality Assurance and Compliance
The Senior Manager of Quality Assurance and Compliance is responsible for establishing and maturing an effective quality and compliance program across Operational areas. This includes evaluating operational controls, guidelines, tools and processes for monitoring, reviewing audits meet accuracy, timeless and contractual obligations, and enhancing operational processes. This role oversees serves as the second line of defense for the organization ensuring the organization is adhering to regulations and maintain high quality standard in operations. This function plays a vital role in ensuring the accuracy, timeliness, and efficiency of operations processing and maintaining compliance with regulatory and operational requirements.What You'll Do
- Responsible for developing and implementing a quality assurance program, reviewing audits meet accuracy, timeless and contractual obligations, and enhancing operational processes.
- Partner with Ops leadership to design and develop an effective Quality Assurance and Compliance program gaining alignment on methodology, audit approach, KPIs, standards and issue resolution process
- Manage quality and Compliance reporting. Coordinate accurate and timely submission of data, including audit readiness and documentation standards for Operations
- Collaborate with operational partners to align workflows, address barriers to performance, and implement initiatives to enhance operations and member satisfaction.
- Monitor and communicate performance trends track and analyze key performance indicators (KPIs). Share actionable insights and recommendations with senior leadership to inform strategic planning and resource allocation.
- Establish effective governance framework to include Audit the Auditor mechanism to achieve organizational goals related to quality and compliance.
- Lead a team of quality assurance and compliance professionals mentoring, fostering positive team culture, promote leadership growth, encourage innovation, and continuous learning to achieve team or individual goals
- Identifying trend and areas of opportunity for process improvements and additional training Work closely with operations leadership to review finding, develop action plans and remediate issues
- Partner with operational leadership to review finding, develop corrective action plans, and remediate identified issues to the root cause ensuring a closed loop process
- Monitor industry trends, regulatory changes and current events to ensure team remains informed and adapts to evolving policies and procedures.
- Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)
- We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.
- Actively support the achievement of SCAN’s Vision and Goals.
- Other duties as assigned.
Your Qualifications
- Bachelor’s Degree required. Graduate or Advanced Degree or equivalent experience preferred.
- Audit Certification preferred
- 5 years of related experience QA and compliance operations experience with Medicare and Medicaid
- 3+ years’ management experience in healthcare environment, preferably Medicare Advantage
- 8+years of progressive experience in healthcare operations
- Experience managing Quality Assurance and/or Operations audit team
- Experience working with AI or other machine learning tools to assist with streamlining QA processes
- Deep experience in operational areas such as claims, configuration, provider data, benefits, enrollment, appeals and grievances
- Proven success leading quality and compliance in a matrixed environment
- Strong working knowledge of CMS and state regulations and operational implications
- Leadership - Skilled to develops others
- Problem Solving - Make critical decisions, often involving high-level risk assessment and the ability to adapt to changing circumstances
- Strategic Mindset - Formulates strategy and maps steps to achieve strategic goals
- Business Insight - In-Depth understanding of the business
- Oral and written communication skills. Problem management. Judgement. Detail oriented. Interpersonal skills.
- Strong analytical and critical thinking skills
- Detail oriented, organized and strong time management skills
What's in it for you?
- Base salary range: $125,400 to $181,419 per year
- Work Mode - Mostly Remote
- An annual employee bonus program
- Robust Wellness Program
- Generous paid-time-off (PTO)
- Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
- Excellent 401(k) Retirement Saving Plan with employer match and contribution
- Robust employee recognition program
- Tuition reimbursement
- An opportunity to become part of a team that makes a difference to our members and our community every day!
At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.
SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
Equal Opportunity Employer/Protected Veterans/Individuals With Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
Key skills/competency
- Quality Assurance
- Compliance
- Healthcare Operations
- Medicare Advantage
- Medicaid
- Auditing
- Process Improvement
- Leadership
- Regulatory Compliance
- Data Analysis
Skills & topics
- Quality Assurance
- Compliance
- Healthcare
- Management
- Auditing
- Medicare
- Medicaid
- Operations
- Regulatory Compliance
- Leadership
How to get hired
- Tailor your resume: Highlight Medicare/Medicaid QA and compliance experience.
- Showcase management skills: Emphasize your 3+ years leading healthcare teams.
- Quantify achievements: Use data to demonstrate impact on quality and compliance.
- Address AI curiosity: Mention any experience or interest in AI for QA processes.
- Prepare for interviews: Be ready to discuss strategic thinking and problem-solving.
Technical preparation
Familiarize yourself with CMS and state regulations.,Understand Medicare Advantage and Medicaid compliance.,Review QA methodologies and audit processes.,Explore AI tools for QA streamlining.
Behavioral questions
Describe a time you improved a QA process.,How do you handle compliance issues?,Explain your leadership style for QA teams.,How do you analyze performance trends?
Frequently asked questions
- What are the key responsibilities for a Senior Manager, Quality Assurance and Compliance at SCAN?
- The Senior Manager of Quality Assurance and Compliance at SCAN is responsible for developing, implementing, and maturing the organization's quality and compliance programs across operational areas. This includes evaluating controls, reviewing audits for accuracy and timeliness, enhancing operational processes, managing quality reporting, and leading a team of QA professionals to ensure adherence to regulations and high-quality standards.
- What qualifications are essential for the Senior Manager, Quality Assurance and Compliance role at SCAN?
- Essential qualifications include a Bachelor's Degree (advanced degree preferred), 5 years of QA and compliance operations experience with Medicare and Medicaid, and 3+ years of management experience in a healthcare environment, ideally Medicare Advantage. Deep experience in operational areas like claims, benefits, and enrollment, along with a strong understanding of CMS and state regulations, is crucial.
- Does SCAN prefer candidates with specific certifications for this role?
- While not strictly mandatory, an Audit Certification is preferred for the Senior Manager, Quality Assurance and Compliance position at SCAN. Candidates with relevant certifications may have a stronger application.
- What is the work arrangement for the Senior Manager, Quality Assurance and Compliance position?
- The work arrangement for this position is described as 'Mostly Remote', indicating a significant portion of the work can be done from outside the office, offering flexibility to employees.
- What is the salary range for the Senior Manager, Quality Assurance and Compliance role at SCAN?
- The base salary range for the Senior Manager, Quality Assurance and Compliance position at SCAN is $125,400 to $181,419 per year. This range reflects the experience and responsibilities associated with the role.
- What kind of benefits does SCAN offer to its employees?
- SCAN offers a comprehensive benefits package, including an annual employee bonus program, a robust wellness program, generous paid-time-off (PTO), eleven paid holidays plus additional holidays, an excellent 401(k) retirement savings plan with employer match, a robust employee recognition program, and tuition reimbursement.
- How does SCAN approach diversity and inclusion in its hiring process?