Quality and Control Manager, Licensure & Enrollment

BrightSpring Health Services•Lyndon, KY

About The Position

The Quality and Control Manager, Licensure & Enrollment, is part of the Legal Department at BrightSpring Health Services, a national, publicly traded healthcare company. The role leads the development and evolution of a comprehensive quality control program for Medicare and Medicaid enrollments and healthcare business and service licenses across multiple jurisdictions. It translates complex regulatory requirements into effective controls, reliable processes, and actionable insights to help maintain accurate, current, and compliant licenses and enrollments. Working with Legal, operations, revenue cycle, finance, provider and pharmacy teams, and state and federal agencies, the manager identifies risks, strengthens oversight of deadlines, and improves accuracy, accountability, and efficiency. The role establishes standardized quality control methods, improves reporting and database integrity, leads corrective action initiatives, and develops a scalable quality control function that supports business growth and continuity while reducing regulatory and financial risk. Travel is 0–10%.

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.
Demonstrated ability to design, implement, and lead a quality control or compliance program, including standardized methodology, controls testing, and continuous monitoring.
Exceptional organizational skills and attention to detail, with the 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 clear quality control documentation, findings, risk assessments, recommendations, and status reports supported by evidence.
Advanced proficiency with Microsoft Office, particularly Excel.
Experience using databases, workflow tools, dashboards, or other tracking systems.
Leadership, coaching, and people-management skills, including the ability to guide and develop staff.
Ability to work with governmental agencies and interpret or apply regulatory requirements to license and enrollment records.
Sound 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 when needed.
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.
Five or more years of relevant experience in a multi-state healthcare environment.
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, ensuring renewals, revalidations, and other required changes are tracked accurately and completed on time.
Direct the development and maintenance of complete 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 state and federal agencies to monitor renewal, revalidation, expiration, and other due dates.
Develop a process to detect and address off-cycle recredentialing requests before credentials lapse.
Lead reviews of enrollment and license records, agency correspondence, renewal calendars, alerts, approval records, and retention records for accuracy, completeness, and compliance.
Ensure changes to business or service licenses are evaluated for potential effects on Medicare and Medicaid enrollments and other licenses.
Serve as a primary contact for state and federal agencies to clarify requirements, verify status, obtain supporting 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 missed or expired licenses, late renewals or revalidations, inaccurate or incomplete records, and control weaknesses; escalate material risks and drive timely resolution.
Prepare and present quality control reports documenting observations, risk levels, evidence, and recommendations for leadership.
Lead the development of management action plans, assign remediation owners and target dates, and confirm corrective actions are completed.
Lead development and implementation of corrective action plans addressing control weaknesses and process gaps to reduce compliance, operational, and financial risk.
Establish standardized quality control methodology, documentation standards, checklists, and reporting tools, and identify opportunities for automation and process improvement.
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 all aspects of the licensure and enrollment database, working 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.