Quality Improvement & Compliance Manager

Seen Health • Alhambra, AZ

7d • Onsite

About The Position

Seen Health is revolutionizing senior care through the PACE model, integrating comprehensive medical care and social support with a high-touch, interdisciplinary approach. We are a culturally-focused, technology-enabled healthcare organization aiming to empower seniors to age-in-place with dignity. This role translates Seen Health's quality and compliance strategy into reliable day-to-day execution. It identifies and investigates compliance risks, ensures thorough evaluation of participant concerns, manages regulatory monitoring and corrective actions, and drives deficiencies to sustainable resolution. The Manager serves as the Director's primary operational partner, independently managing routine and moderately complex quality and compliance matters while escalating significant organizational risk.

Requirements

• Bachelor's degree in healthcare administration, public health, nursing, quality, business, or related field (equivalent substantial experience considered)
• 4+ years of healthcare quality, compliance, regulatory, managed-care, or clinical operations experience
• Experience conducting audits or investigations, and managing corrective actions and regulatory deadlines
• Supervisory, project leadership, or team-lead experience
• Professional verbal fluency in Mandarin required, sufficient to independently conduct participant/caregiver interviews and investigate grievances
• Ability to commute to Alhambra required

Nice To Haves

• Cantonese preferred
• PACE experience
• CMS/DHCS regulatory experience
• Grievance/appeals/participant-rights investigation experience
• A clinical license or quality/compliance certification

Responsibilities

• Execute the annual QIC monitoring and audit plan; conduct or assign targeted audits
• Review findings for severity, frequency, regulatory exposure, and participant impact; track corrective actions through verified closure
• Escalate material or repeat deficiencies to the QIC Director
• Own grievance administration: confirm classification, lead fact-finding and interviews, evaluate evidence, and ensure written resolutions are complete and appropriate
• Track remedies and corrective actions; review trends for systemic issues and escalate significant participant-rights or regulatory concerns
• Translate CMS, DHCS, and other regulatory requirements into monitoring tools and crosswalks
• Conduct compliance reviews and support departments in interpreting and implementing requirements
• Escalate unresolved regulatory risk
• Ensure CAPs identify root cause, corrective action, owner, due date, monitoring methodology, and effectiveness evidence
• Reopen or revise CAPs that don't demonstrate effectiveness
• Coordinate internal audit readiness, maintain evidence repositories, conduct mock reviews, and support CMS/DHCS audits
• Directly supervise the QIC Coordinator: assign priorities, review work quality, coach performance, and build technical competency
• Review dashboards and trends, support PIPs, and ensure improvement actions have accountable owners
• Identify QIC workflows suited for AI/automation; validate that automated monitoring accurately detects what it's designed to catch
• Review AI-generated findings for accuracy before incorporating into audits, investigations, or compliance conclusions
• Ensure staff apply professional judgment rather than relying on AI output alone

Benefits

• Medical, Dental, and Vision benefits for you and your family
• Life Insurance and Disability Benefits
• Parental and Caregiver Leave
• Lunch, as well as delicious snacks and coffee to keep you energized
• Paid Time Off across holidays, vacation time, personal days, and sick days
• 401k Plan
• Personal and professional development, including CME support and career growth opportunities
• Subscriptions and training on using AI tools including ChatGPT
• Relocation benefits available

What This Job Offers

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