Quality and Control Manager, Licensure & Enrollment

BrightSpring Health Services•Louisville, KY

About The Position

The Quality and Control Manager, Licensure & Enrollment leads a quality control program overseeing Medicare and Medicaid enrollments and healthcare business and service licenses across multiple jurisdictions. The role turns complex regulatory requirements into effective controls, reliable processes, and actionable insights to help ensure that licenses and enrollments remain accurate, current, and compliant. It works collaboratively with Legal, operations, revenue cycle, finance, provider and pharmacy teams, and state and federal agencies to identify risks, strengthen oversight of deadlines, improve reporting and database integrity, and lead corrective actions. The manager also establishes standardized quality control methodologies, supports continuous improvement, and builds a scalable function to support company growth and reduce regulatory, financial, and operational risk. BrightSpring Health Services provides home- and community-based health solutions for complex populations, including pharmacy, home health care, and rehabilitation services. It operates in all 50 states and serves more than 475,000 customers, clients, and patients daily.

Requirements

Bachelor’s degree in business, healthcare administration, accounting, legal studies, compliance, or a related field.
At least five years of relevant experience in healthcare licensure, Medicare or Medicaid provider enrollment, pharmacy enrollment, quality control, compliance, or regulatory operations.
Strong working knowledge of Medicare and Medicaid enrollment, healthcare business and service licensing, renewals, revalidations, and related regulatory requirements.
Ability to design, implement, and lead a quality control or compliance program, including standardized methodology, controls testing, and continuous monitoring.
Exceptional organization and attention to detail, including ability to manage multiple workstreams, records, deadlines, and follow-up actions.
Excellent written and verbal communication skills, including presenting findings and recommendations to leadership, business partners, and government agencies.
Ability to prepare quality control documentation, findings, risk assessments, recommendations, and evidence-supported status reports.
Advanced proficiency with Microsoft Office, particularly Excel.
Experience using databases, workflow tools, dashboards, or other tracking systems.
Leadership, coaching, and people-management skills to guide and develop supporting staff.
Ability to work with governmental agencies and interpret or apply regulatory requirements to license and enrollment records.
Strong judgment, professional skepticism, problem-solving ability, and commitment to accuracy and continuous improvement.
Ability to collaborate across Legal, revenue cycle, finance, operations, provider, and pharmacy functions and influence outcomes without direct authority.
Ability to maintain confidentiality of sensitive legal, regulatory, provider, patient, financial, and business information.

Nice To Haves

Advanced degree such as an MBA, MHA, or JD.
Multi-state healthcare experience.
Certified Manager (CM), Certified in Healthcare Compliance (CHC), Lean Six Sigma Black Belt, or similar quality management or compliance certification.

Responsibilities

Oversee quality control reviews of active and upcoming enrollments and licenses to verify renewals, revalidations, and required changes are tracked accurately and completed on time.
Direct development and maintenance of inventories of active and upcoming enrollments and licenses subject to quality control review.
Partner with the Licensure & Enrollment team, revenue cycle, provider and pharmacy contracting, and government agencies to monitor renewal, revalidation, expiration, and other due dates.
Develop a process to detect and address off-cycle recredentialing requests before credentials lapse.
Review enrollment and license records, agency correspondence, renewal calendars, alerts, approvals, and retention records for accuracy, completeness, and compliance.
Ensure changes to business or service licenses are evaluated for potential impact on Medicare and Medicaid enrollments and other licenses.
Serve as a primary contact for state and federal agencies to clarify requirements, verify status, obtain information, and resolve quality control questions or discrepancies.
Evaluate quality control results against internal policies and procedures, regulatory requirements, and financial controls for enrollment and license payments and renewals.
Identify expired or missed licenses, late renewals or revalidations, inaccurate or incomplete records, and control weaknesses; escalate material risks and drive resolution.
Prepare and present reports documenting observations, risk levels, evidence, and recommendations for leadership.
Lead development of management action plans, assign remediation owners and target dates, and confirm corrective actions are complete.
Lead corrective action plans to address control weaknesses and process gaps and reduce compliance, operational, and financial risk.
Establish standardized quality control methodology, documentation standards, checklists, and reporting tools; identify automation and process improvement opportunities.
Provide guidance, training, and quality oversight to team members supporting the quality control function.
Maintain confidentiality when handling sensitive legal, regulatory, provider, patient, financial, and business information.
Oversee the licensure and enrollment database and work with business lines to ensure licenses and enrollments are maintained in it.
Strengthen governance, standardize quality control methodology, and build a scalable quality control function.