Quality and Compliance Manager CA - Remote

Medzed LLC•Old Fig Garden, CA

7d•$90,000 - $115,000•Hybrid

About The Position

The Quality & Compliance Manager is responsible for designing, implementing, and monitoring the organization's compliance and regulatory risk control frameworks across in-home healthcare operations. Reporting directly to the VP of Quality & Compliance, this role serves as a central resource for ensuring that MedZed's programs, contracts, and internal processes adhere to federal and California state regulatory requirements — including Medi-Cal, IHSS, CBAS, and applicable managed care contract obligations. The Program Manager leads cross-functional compliance initiatives, tracks corrective action plans, and supports audit readiness across all service lines.

Requirements

3+ years of direct experience in compliance monitoring, regulatory risk controls, and contract risk management in a healthcare setting.
3+ years managing internal compliance controls, including audit functions, corrective action plans, and controls documentation.
Demonstrated knowledge of California healthcare regulatory environment, including Medi-Cal, DHCS requirements, and managed care contract compliance.
Experience working in or alongside in-home healthcare, community-based services, or a similar field-operations model strongly preferred.
Bachelor’s degree in healthcare administration, Public Health, Business Administration, or a related field required.
Demonstrated ability to manage multiple workstreams in a dynamic program management environment.
Ability to work with and through others in a matrixed leadership role.
Strong command of federal healthcare regulations, including HIPAA, ACA, and Medi-Cal managed care rules.
Skilled in building and managing compliance frameworks, risk matrices, and audit programs from the ground up.
Ability to translate regulatory requirements into clear, operational policies and staff-facing training.
Excellent written and verbal communication; able to present complex compliance information to non-technical audiences.
Proficient in Microsoft 365 (Excel, Word, SharePoint); experience with compliance management systems or GRC platforms a plus.

Nice To Haves

Master's degree (MHA, MPH, MBA) or Juris Doctor preferred.
Certified in Healthcare Compliance (CHC) through the Health Care Compliance Association (HCCA) or Certified Internal Auditor (CIA) through the Institute of Internal Auditors preferred.
Bilingual (English/Spanish) a plus given the populations MedZed serves.

Responsibilities

Design and maintain a regulatory compliance monitoring calendar covering DHCS, DMHC, CMS, and applicable county contract requirements.
Conduct ongoing monitoring of federal and California regulatory changes; assess operational impact and drive timely policy updates.
Develop and manage risk matrices for regulatory and contract obligations; escalate material risks to the VP of Quality & Compliance.
Coordinate responses to regulatory inquiries, desk reviews, and on-site surveys; prepare supporting documentation and track findings to resolution.
Monitor compliance with Medi-Cal managed care contract terms, IHSS program requirements, and other payer or county obligations.
Build and maintain an internal compliance controls library, including policies, procedures, attestations, and audit tools.
Conduct routine internal audits and testing across clinical operations, billing, documentation, and vendor management.
Lead root cause analysis for compliance findings; develop and track corrective action and performance improvement plans (CAPs/PIPs).
Coordinate with department managers to embed compliance controls into day-to-day workflows and onboarding processes.
Maintain compliance issues log and produce monthly dashboards for leadership review.
Review and assess new and renewing contracts for compliance risk, including payer agreements, subcontractor arrangements, and vendor contracts.
Maintain contract obligations tracker; monitor adherence to reporting deadlines, notice requirements, and performance standards.
Partner with legal counsel and operations on contract language related to HIPAA, scope of services, and regulatory compliance.
Support rate negotiations and program expansions with compliance impact analyses.
Develop and deliver compliance training for Community Health Navigators (CHNs) and program staff, including annual and role-specific curricula.
Maintain a training completion tracking system and report gaps to the VP of Quality & Compliance.
Act as a day-to-day compliance resource for field staff, responding to questions and escalating issues as appropriate.
Prepare compliance reports, board updates, and regulatory submissions as directed by the VP.
Maintain organized, audit-ready compliance records and documentation in accordance with retention policies.