Quality Improvement & Compliance Manager

About the Role

The Quality Improvement & Compliance (QIC) Manager translates Seen Health's quality and compliance strategy into reliable day-to-day execution. This role identifies and investigates compliance risk, ensures participant concerns are thoroughly evaluated, manages regulatory monitoring and corrective action, 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.

Responsibilities

Quality & Compliance Monitoring

• 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

Grievance Investigation & Administration

• 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

Regulatory Compliance

• 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

Corrective Action Management

• Ensure CAPs identify root cause, corrective action, owner, due date, monitoring methodology, and effectiveness evidence
• Reopen or revise CAPs that don't demonstrate effectiveness

Regulatory Readiness

• Coordinate internal audit readiness, maintain evidence repositories, conduct mock reviews, and support CMS/DHCS audits

Team Supervision

• Directly supervise the QIC Coordinator: assign priorities, review work quality, coach performance, and build technical competency

Quality Improvement Oversight

• Review dashboards and trends, support PIPs, and ensure improvement actions have accountable owners

AI-Enabled QIC Operations

• 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

Qualifications

• 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 and Cantonese preferred, sufficient to independently conduct participant/caregiver interviews and investigate grievances;
• PACE experience, CMS/DHCS regulatory experience, grievance/appeals/participant-rights investigation experience, and a clinical license or quality/compliance certification are all preferred

Location

• Los Angeles required. Ability to commute to Alhambra required.
• Relocation benefits available.

Salary & Benefits