Manager, Quality and Compliance

Job Description

Job DescriptionDescription:

JOB DESCRIPTION

Job Title: Manager, Quality and Compliance

Reports To: Chief, Program Evaluation and Strategic Initiatives

Department: Quality and Compliance

FLSA Status: Exempt

Non-Union

Position Summary:

The Quality and Compliance Manager leads vendor contract oversight, regulatory compliance, and quality improvement initiatives for the agency. This role reports to the Chief of Program Evaluation and Strategic Initiatives and manages provider relationships, oversees procurement processes (RFPs/RFRs), and ensures contracts meet legal and programmatic standards. As the primary coordinator for accreditation and regulatory readiness, the manager ensures timely documentation and audit preparation. Working cross-functionally, the role drives performance measurement, maintains incident reporting systems, and supports continuous quality improvement through data analysis and policy updates. Strong project management, regulatory knowledge, and collaboration skills are essential for success.

Job Responsibilities and Performance Standards:

Vendor and Contracts Management

• Manage all agency vendor and provider contracts to ensure compliance with contractual terms, regulatory requirements, and performance expectations.
• Lead the full lifecycle of the Request for Proposals (RFP) and Request for Responses (RFR) processes, as scheduled by the Executive Office of Aging & Independence (AGE) and other regulatory entities, including drafting, dissemination, evaluation, selection, and contract initiation for new service providers.
• Oversee provider monitoring through audits, performance reviews, site visits, surveys, incident reporting, and regular staff engagement. Ensure vendors meet required quality and service standards.
• Cultivate and maintain strong, collaborative relationships with provider agencies through regular communication, quarterly meetings, issue resolution, and timely dissemination of regulatory or policy updates.
• Maintain up-to-date records of contract terms, rates, amendments, and provider status in both internal systems and statewide databases. Ensure timely updates to reflect changes in scope, rates, or service availability.
• Train internal staff on regulatory and contractual changes that affect provider obligations. Act as a subject matter expert on vendor policies, processes, and compliance standards.
• Work closely with agency leadership and fiscal team to analyze service utilization trends and vendor capacity, identifying geographic or programmatic gaps.
• Provide data-driven recommendations to support vendor network development—identifying needs for new providers, areas of oversaturation, or opportunities for improved service alignment.

Accreditation & Regulatory Compliance

• Serve as the primary coordinator for accreditation and regulatory readiness and maintenance for NCQA, AGE Designation Review, and other regulatory reviews.
• Maintain up-to-date regulatory and accreditation standards and communicate requirements across departments.
• Manage and maintain the Quality and Compliance SharePoint site and publish relevant reports, tools, and documentation for staff use.
• Prepare and submit annual assessments, updates, and other regulatory filings.
• Coordinate intra-cycle monitoring, document preparation, and designation readiness activities.
• Ensure all documentation required by accrediting and regulatory bodies is identified, updated, and indexed appropriately.
• Conducts internal regulatory audits and organizational risk assessments, ensuring proactive identification, mitigation, and monitoring of compliance-related risks.

Quality Improvement & Performance Measurement

• Partner with the Quality and Compliance Committee Chair to update and communicate SCES’s Quality Improvement Plan, support the committee and its subcommittees in maintaining accurate records, and provide technical support.
• Collaborate with IT, Data Analytics, and departments to maintain dashboards, monitor key performance indicators (KPIs), and track and drive improvements in clinical, operational, and educational outcomes.
• Maintain the organization’s incident reporting system, ensure timely internal follow-up and external reporting to regulatory bodies, and monitor incident trends to inform policy revisions and support continuous quality improvement initiatives.
• Coordinate reporting to external bodies such as MA EOHHS, AGE, CMS, and NCQA.
• Ensure compliance with mandated and voluntary reporting requirements.
• Integrate outcome indicators into enterprise-wide reporting cycles (weekly, monthly, quarterly, annually).
• Coordinate training opportunities on quality improvement methodologies for staff across departments.
• Stay informed about industry best practices and regulatory changes from NCQA, EOHHS, AGE, and other relevant bodies.
• Other duties as assigned.

Professional Standards and Conduct:

• Leadership: Ability to lead, inspire, and empower staff by demonstrating confidence and leadership presence. Passion and commitment to establishing and developing evidence-based programming for individuals to live in the setting of their choice with dignity and for as long as possible.
• Collaborative and Responsive: Regularly communicates, follows up, and uses a team-driven approach. Responds thoughtfully and promptly to agency needs, requests, and inquiries; identifies and builds partnerships with key stakeholders. Has excellent organizational and time management skills to meet various deadlines, ensuring closed-loop communication, multi-tasking, and maintaining flexibility to adapt and adjust workload assignments based on various needs.
• Communication: Skilled in verbal and written communication, demonstrating the ability to communicate information in numerous ways to meet diverse styles and cultural backgrounds.
• Analytical: Critical thinking skills, using logic and reasoning to identify the strengths and opportunities of alternative solutions, conclusions, or approaches to problems.
• Attendance and Punctuality: Dependable, punctual, showing flexibility when needed. Attends meetings as needed and is fully present and participates during those meetings.
• Commitment: Embodies SCES’s core values and shows great integrity, accountability, and professionalism in all interactions. Aids in furthering SCES’s mission and commitment to an inclusive environment.

Qualifications:

• A bachelor’s degree or 10 years of relevant experience in healthcare regulatory compliance is required.
• Extensive knowledge of NCQA, EOHHS, and Executive Office of Aging and Independence regulatory and accreditation processes and standards.
• Prior experience in quality improvement, performance measurement, or compliance in healthcare.
• Strong knowledge of healthcare administration, quality standards, and regulatory accountability.
• Strong knowledge of the different continuous quality improvement frameworks such as PDSA, Lean, Six-Sigma, and RCA.
• Excellent organizational, analytical, and critical thinking skills.
• Exceptional oral, written, and interpersonal communication skills.
• Proficiency in Microsoft Office Suite and ability to learn additional systems.
• Ability to work independently and collaboratively with diverse populations.
• Exceptional time management and organizational proficiency.
• Must meet both CORI/SORI and public health screening requirements.

Physical Environment

• Physical surroundings are comfortable with minimal exposure to injury or hazards.

Social/Psychological Conditions

• Occasional stress due to periodic or cyclical workload pressures and deadlines. Some interruptions are involved.

Physical Effort

• Frequently sits, stands, walks, bends, reaches, and stoops throughout the day.
• Frequently lifts, pulls, pushes, and carries up to 20 lbs.
• Periodic eye strain and light ear strain.

Requirements: