Associate Director of Compliance & Quality Improvement

Casa Esperanza•Malden, MA

1d•Hybrid

About The Position

The Associate Director of Compliance & Quality Improvement is a key leadership role responsible for designing, implementing, and managing a comprehensive compliance program across the behavioral health system. Reporting directly to the Director of Clinical Operations & Network Strategy, this position ensures that all organizational activities, clinical operations, and business practices adhere to federal, state, and payer regulations, internal policies, and ethical standards. The Associate Director will establish and lead the compliance infrastructure—developing systems, policies, and processes that minimize organizational risk, ensure readiness for audits, and drive quality improvement. The role will require close collaboration with departments including Payer Relations, Provider Relations, Practice Management, Quality, Human Resources, Clinical Operations, Finance, and others to ensure a culture of compliance and accountability across the enterprise.

Requirements

Minimum 4 - 5 years of experience in healthcare compliance, preferably within behavioral health, mental health, or integrated care systems.
Demonstrated experience building and leading compliance programs or departments.
Strong background in payer compliance, audits, and risk mitigation.
Knowledge of federal and state healthcare regulations, including HIPAA, CMS, OIG, and behavioral health licensing standards.
Proven ability to manage complex compliance initiatives and cross-departmental collaboration.
Strong analytical, investigative, and project management skills.
Exceptional written and verbal communication skills for training, policy development, and leadership reporting.
Strategic thinker with the ability to operationalize compliance frameworks into scalable systems.

Nice To Haves

Certified in Healthcare Compliance (CHC) or Certified Professional Compliance Officer (CPCO) or willingness to obtain certification within one year of employment

Responsibilities

Compliance Program Leadership
Design, implement, and oversee the organization’s Compliance Department and comprehensive compliance program, ensuring alignment with regulatory requirements, accreditation standards, and organizational goals.
Develop, update, and enforce compliance policies and procedures covering clinical, operational, billing, privacy, and administrative activities.
Establish mechanisms for reporting, investigating, and resolving compliance concerns, ensuring timely and appropriate corrective actions and performance improvement projects.
Create and maintain a compliance governance structure, that includes regular reporting to the leadership teams in conjunction with the Director of Clinical/Medical Operations & Network Strategy & Development which provides compliance forecasting on a continuous basis
Monitor regulatory developments in behavioral health and ensure timely communication and implementation of necessary changes.
Regulatory Oversight & Risk Management
Oversee compliance with all applicable federal and state regulations, including HIPAA, CMS, Medicaid, Medicare, CARF, and other/payer-specific standards as needed
Develop a risk assessment framework to identify, prioritize, and mitigate potential areas of compliance vulnerability.
Conduct and manage internal audits and monitoring activities to ensure accuracy and integrity in billing, documentation, clinical operations, and administrative practices.
Lead investigations into compliance violations, coordinate corrective actions, and ensure follow-up and documentation.
Serve as the organizational liaison for external audits, payer reviews, and regulatory inspections.
Prepare comprehensive compliance reports and risk analyses for executive leadership.
Program Management & Quality Initiatives
Establish and manage a structured Compliance Program Management Office (PMO) for overseeing ongoing and ad hoc compliance and quality improvement initiatives.
Plan, lead, and track organization-wide projects focused on audit readiness, quality improvement, and risk reduction.
Collaborate with Clinical and Operations leadership to align quality and compliance initiatives with performance improvement goals.
Implement data-driven compliance dashboards and tracking systems for real-time visibility into key compliance indicators.
Partner with the Quality and Clinical Operations teams to ensure performance improvement activities support regulatory compliance and best practices.
Collaboration & Cross-Functional Engagement
With the collaboration of the Director, Clinical/Medical Operations & Network Strategy & Development work in close partnership with:
Payer Relations to ensure adherence to payer contract requirements, credentialing standards, and utilization review expectations.
Provider Relations to reinforce provider education, training, and compliance with documentation, coding, and clinical protocols.
Practice Management to maintain compliant workflows, patient privacy standards, and operational efficiency.
Human Resources to manage compliance training programs, employee onboarding education, and disciplinary processes when appropriate.
Finance & Billing Teams to ensure claims integrity and compliance with reimbursement requirements.
Serve as a trusted compliance advisor to operational leaders, ensuring integration of compliance considerations in all decision-making processes.
Training, Education & Culture
Develop and implement a comprehensive compliance training and education program for staff and leadership at all levels.
Promote a proactive culture of compliance, ethics, and transparency throughout the organization.
Provide ongoing guidance and mentorship to department leaders to strengthen internal accountability and compliance ownership.