Quality and Compliance Officer

Adobe Care And Wellness LLC•Phoenix, AZ

3d•Hybrid

About The Position

Adobe Population Health (APH) is seeking an experienced and strategic Quality and Compliance Officer to lead the organization’s quality management, regulatory compliance, and risk mitigation efforts. This role is responsible for ensuring that APH maintains the highest standards of operational integrity, regulatory adherence, and continuous quality improvement across all programs and services. The Quality and Compliance Officer plays a critical leadership role in developing and overseeing the organization’s Quality Assessment and Performance Improvement (QAPI) program, regulatory compliance framework, accreditation readiness, and risk management initiatives. Working closely with executive leadership, clinical teams, and operational stakeholders, this position ensures that policies, procedures, and performance metrics align with federal and state regulations, payer contractual obligations, and accreditation standards, including NCQA and URAC. This leader will foster a culture of accountability, transparency, and continuous improvement by leveraging data analytics, monitoring performance indicators, and implementing quality initiatives that enhance member outcomes and operational effectiveness. The role also serves as the primary liaison for regulatory agencies, health plan partners, and accreditation bodies, ensuring the organization remains audit-ready and compliant while supporting the strategic growth and credibility of APH. This position is based in our Phoenix office (16th St. & Glendale Ave.), conveniently located off the SR-51 freeway. The role operates in a hybrid schedule, with three days in-office and two days remote, Monday through Friday, 8:00 AM – 5:00 PM.

Requirements

A minimum of two (2) years of experience in healthcare quality management, compliance, or a similar leadership role.
In-depth knowledge of healthcare regulations, accreditation standards, and quality improvement methodologies.
Experience leading and managing teams, with strong leadership, coaching, and mentoring skills.
Excellent analytical and problem-solving abilities, with a keen eye for detail.
Strong interpersonal and communication skills, capable of interacting with individuals at all levels of the organization.
Proven track record of implementing successful quality improvement initiatives and driving organizational change.
Familiarity with healthcare IT systems and data analysis tools.
Bachelor’s degree in healthcare administration, nursing, medicine or a related field is required.
Relevant professional work experience may be considered in lieu of a degree.

Nice To Haves

Certified in relevant quality management or compliance-related certifications (e.g., Certified Professional in Healthcare Quality - CPHQ, Certified in Healthcare Compliance - CHC) is a plus.

Responsibilities

Design, implement, and oversee the organization’s Quality Management System to ensure consistent adherence to quality standards across all programs and operations.
Lead the Quality Assessment and Performance Improvement (QAPI) Program, ensuring performance metrics and initiatives meaningfully support operational excellence and improved member outcomes.
Establish and monitor quality objectives, key performance indicators, and outcome metrics in collaboration with cross-functional leadership.
Facilitate quality improvement initiatives that incorporate evidence-based practices and support continuous improvement across care delivery and operational workflows.
Maintain comprehensive knowledge of applicable federal, state, and contractual regulatory requirements, including CMS, OSHA, OIG, and state health agencies.
Ensure ongoing compliance with NCQA and URAC accreditation standards, including preparation for surveys, documentation reviews, and performance measure submissions.
Identify opportunities for additional certifications or accreditations that enhance the organization’s credibility and operational excellence.
Maintain regulatory monitoring systems to track updates and ensure organizational policies and procedures remain compliant.
Provide leadership and oversight of the organization’s Compliance Program, ensuring clear communication of compliance expectations and regulatory obligations across the organization.
Coordinate compliance reporting to health plan partners in accordance with contractual obligations, including quarterly reporting and event-based notifications.
Participate in Joint Operating Committee (JOC) meetings with health plan partners and represent APH’s commitment to regulatory and contractual compliance.
Lead internal and external audits to assess operational effectiveness, regulatory compliance, and adherence to contractual requirements.
Serve as the primary organizational contact for health plan and regulatory audits, managing the audit lifecycle from notification through successful completion.
Prepare and coordinate documentation required for pre-delegation reviews, annual compliance audits, and accreditation assessments.
Ensure corrective action plans are developed and implemented for identified compliance or performance gaps.
Identify, assess, and mitigate operational and regulatory risks affecting the organization, employees, members, and partners.
Oversee the Emergency Response and Disaster Preparedness Program across all states in which APH operates.
Ensure compliance with OSHA standards and workplace safety requirements across all operational locations.
Support the evaluation and implementation of evidence-based clinical practices across care management programs.
Conduct annual reviews of clinical guidelines and program descriptions to ensure alignment with regulatory and accreditation requirements.
Collaborate with clinical leadership to strengthen quality outcomes and improve program effectiveness.
Utilize data analytics to monitor organizational performance indicators and identify trends that inform strategic decision-making.
Prepare reports and performance summaries for executive leadership, governing boards, and regulatory entities.
Coordinate data reporting and performance measure submissions required for NCQA and URAC accreditation.
Oversee the annual review and maintenance of organizational policies, procedures, standard operating procedures (SOPs), and clinical pathways.
Ensure documentation reflects current best practices and regulatory requirements and is effectively communicated and implemented across the organization.
Manage the organization’s policy management platform, ensuring staff have appropriate access to policies and governance materials.
Oversee the organization’s member grievance and complaint process, ensuring timely acknowledgment, investigation, and resolution.
Ensure compliance with required response timelines, including acknowledgment within 10 days and resolution within 30 days.
Partner with leadership to identify systemic issues and implement improvements that enhance member satisfaction and service quality.
Partner with training and leadership teams to develop and deliver education programs related to quality assurance, regulatory compliance, and risk management.
Promote a culture of continuous learning and compliance awareness across the organization.
Supervise and mentor members of the Quality and Compliance team, providing guidance, accountability, and professional development support.
Foster collaboration across departments to strengthen quality initiatives and compliance adherence organization wide.
Maintain effective communication with clinical staff, executive leadership, regulatory bodies, and external partners.
Ensure adherence to HIPAA privacy and security regulations, including employee education, monitoring, and enforcement of data protection policies.