Quality Assurance & Compliance Manager (Part-time/Hybrid) - Medicaid/Behavioral Health

Job Title: Quality Assurance & Compliance Manager (Fractional) — Behavioral Health
Company: Confidential Behavioral Health Organization (Partnered with The Wilkinson Firm)
Location: Remote (with occasional travel to Eastern North Carolina)
Job Type: Contract | Part-Time | Immediate Start

About the Role

A confidential behavioral health organization is seeking a Quality Assurance & Compliance Manager to strengthen internal QA/QI systems across multiple behavioral health programs. This part-time, fractional leadership position focuses on maintaining compliance with Medicaid, MCO, and DHHS standards while supporting audit readiness and documentation integrity.

You’ll work directly with executive and clinical leadership to review processes, identify compliance risks, and implement quality improvement initiatives that enhance both service delivery and billing accuracy.

Key Responsibilities

Quality Assurance & Improvement

• Conduct routine documentation and record reviews to ensure compliance with Medicaid and state standards

• Track and report on QA findings, trends, and corrective actions

• Support leadership in implementing new quality improvement initiatives

• Monitor staff adherence to timelines and escalate persistent issues as needed

Medicaid Authorizations & Utilization

• Oversee the authorization and reauthorization process for behavioral health services

• Track utilization to ensure billing accuracy and avoid service lapses

• Communicate proactively with leadership on any authorization or utilization risks

Data Compliance (NC-TOPPS & Related Systems)

• Monitor NC-TOPPS and related data submission compliance

• Identify and address delayed or inaccurate submissions

• Generate compliance summaries for leadership reporting

Audit Preparedness

• Prepare required documentation for internal and external audits

• Conduct periodic chart reviews to maintain audit-ready status

• Collaborate with clinical, billing, and administrative teams to ensure full compliance

Qualifications

• Education: Bachelor’s degree in Human Services, Healthcare Administration, Behavioral Health, or a related field (or equivalent experience)

• Experience: Minimum 3 years in behavioral health QA/QI, compliance, or utilization review

• Knowledge of:

  • Medicaid, MCO, and DHHS compliance requirements

  • NCTracks, AlphaMCS, or similar authorization systems

  • NC-TOPPS processes and Medicaid documentation standards

  • QA tracking and audit preparation in behavioral health settings

• Skills:

  • Strong documentation and analytical review skills

  • Excellent communication and report writing ability

  • Independent problem-solving and initiative

  • Ability to maintain accountability across multiple departments

Preferred

• Prior experience leading QA/QI or compliance teams within a behavioral health agency

• Experience responding to audits or corrective action plans

• Familiarity with North Carolina Medicaid documentation standards

Role Details

• Schedule: 20–25 hours per week (flexible)

• Compensation: $27–$32 per hour (commensurate with experience)

• Travel: Up to 1–2 times per month within Eastern NC for onsite audits or walkthroughs

• Reporting To: Vice President (QA/QI)

• Department: Quality Assurance / Compliance

Why This Role Matters

This is a high-impact leadership opportunity for someone who thrives on structure, accountability, and quality. As the organization expands, this role carries growth potential to evolve into full departmental leadership, overseeing future QA/QI personnel and compliance systems.

To Apply:
Submit your resume and a brief cover letter highlighting your experience with behavioral health QA/QI, Medicaid compliance, or audit management. Qualified candidates will be contacted for next steps.