The posting
Abound Health is seeking a Quality Manager to join our team in New Jersey. This role is responsible for leading the day-to-day execution of Abound’s quality, regulatory, payer, and contract compliance programs across New Jersey operations. Reporting to the EVP of Quality & Compliance, the Quality Manager partners with operational, clinical, finance/billing, HR, and legal teams to ensure compliance with state and federal requirements, payer policies, and contractual obligations. This is a remote role for applicants who live in NJ.
Key Responsibilities
- Lead New Jersey-specific quality and compliance priorities, workplans, and operating processes.
- Serve as the New Jersey subject-matter lead for quality, compliance, contract requirements, and payer expectations.
- Partner with operations and clinical teams to embed quality and compliance into daily operations, onboarding, supervision, and service delivery.
- Maintain knowledge of New Jersey DDD requirements and documentation standards and translate requirements into workflows and training.
- Partner with billing and finance to monitor claims quality, denials, recoupments, and audit activity and drive corrective actions.
- Oversee payer audit preparation and responses, including medical record requests and pre- and post-payment reviews.
- Support the identification, documentation, and resolution of potential overpayments.
- Oversee the New Jersey incident management process, including timely reporting and tracking of reportable incidents.
- Lead or support investigations and root-cause analysis for incidents, complaints, and grievances.
- Develop and monitor Plans of Correction following investigations.
- Coordinate accreditation and external reviews as applicable.
- Design and execute New Jersey audit and monitoring plans covering documentation, authorizations, contract deliverables, incidents, credentials, and billing support.
- Establish and monitor quality and compliance dashboards and KPIs.
- Provide routine reporting to leadership and escalate material risks and trends.
- Represent quality and compliance in New Jersey payer, DDD, and contract partner interactions as requested.
Qualifications
- Bachelor’s degree in Healthcare Administration, Business, Nursing, Social Work, Public Health, Quality, Compliance, or a related field; Master’s degree preferred.
- 5+ years of progressive experience in healthcare quality/compliance.
- Direct experience with payer requirements, contract compliance, and incident reporting in a regulated environment.
- Experience in behavioral health, I/DD, HCBS, or a similar setting preferred.
- Experience with New Jersey DDD, Medicaid Waiver, or NJ FamilyCare requirements strongly preferred.
- Knowledge of compliance programs, auditing/monitoring, credentialing, corrective action, and training programs.
- Working knowledge of New Jersey incident reporting requirements, background check/CARI processes, and mandatory reporting laws.
- Ability to interpret contracts, payer manuals, and regulations and translate them into practical operational processes.
- Strong communication, collaboration, project management, and analytical skills.
- Ability to influence and collaborate effectively across teams.
Compensation & Benefits
The target base salary range for this full-time position is $60,000-$65,000.
Base pay is determined by factors such as location, experience, job-related skills, and relevant training. Total compensation includes a comprehensive benefits package, competitive health/dental/wellness coverage, and 401(k) eligibility after 12 months. Contact your Talent Acquisition Partner for more information.
Equal Employment Opportunity
Abound Health is an equal opportunity employer. We evaluate all qualified applicants without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity/expression, veteran status, disability, or any other legally protected characteristic.
#li-remote
