Director of Payer Compliance & Quality Assurance

Embark Behavioral Health • Chandler, AZ

10h • Onsite

About The 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.

Requirements

• 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

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

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior