Director of Clinical Operations & Compliance

Director of Clinical Operations & Compliance CareChoice Homecare Wyncote, PA Job Details Full-time $80,000 - $90,000 a year 19 hours ago Benefits Health insurance Dental insurance 401(k) Paid time off Vision insurance Life insurance Qualifications Quality control corrective actions Teamwork Client onboarding Operations management RN License Hospice experience Hospice care Healthcare fraud investigations Compliance audits & assessments Corrective and preventive actions (CAPA) Research Complaint handling State healthcare regulations Quality assurance audits Clinical staff training Supervising experience Team management Staff training Quality improvement Regulatory affairs Clinical documentation Healthcare team management Investigative reports Home health Overseeing audit functions Senior level Managing patient records Home health agency experience Care plans Leadership Healthcare compliance Communication skills Under 1 year Nursing Full Job Description CareChoice Homecare is seeking an experienced Director of Clinical Operations & Compliance (RN) to oversee our Clinical and Quality Assurance teams across all CareChoice operating states, currently five states, with a primary focus on Pennsylvania. This is a leadership role for a highly organized, detail-oriented RN who understands home care regulations, documentation compliance, supervisory visit requirements, Plan of Care deadlines, intake compliance, complaint investigations, and MCO audit readiness. The ideal candidate will be responsible for ensuring that CareChoice remains fully compliant with state, federal, Medicaid, and MCO requirements while supporting strong clinical oversight and quality care for our clients. Key Responsibilities Supervise and manage the Clinical Team and Quality Assurance Team. Oversee regulatory compliance and quality assurance operations across all CareChoice states, with a primary focus on Pennsylvania. Conduct systematic reviews and audits of client charts, caregiver files, clinical documentation, Plans of Care, supervisory visits, wellness visits, and other required compliance records. Ensure all client and caregiver records are complete, accurate, organized, and audit-ready. Ensure all Plans of Care are completed, reviewed, updated, and signed within required deadlines. Monitor compliance with MCO, Medicaid, state, federal, and agency requirements. Oversee completion of supervisory visits and wellness visits, including required six-month visits and any additional visits required by payer or agency policy. Review intake compliance to ensure new clients are properly onboarded with all required documentation before services begin. Work closely with EVV, Case Management, Intake, Scheduling, HR, and Operations teams to identify and resolve possible compliance issues. Prepare client and caregiver charts for internal audits, MCO audits, state audits, and payer reviews. Identify missing documentation, compliance gaps, and process issues, then create corrective action plans. Investigate complaints involving fraud, abuse, neglect, service concerns, caregiver issues, documentation concerns, or quality-of-care issues. Prepare written investigation summaries and professional responses to MCOs, state agencies, and internal leadership. Provide training, coaching, and guidance to clinical and QA staff. Track audit results, complaint investigations, corrective actions, documentation deadlines, and compliance trends. Support company-wide compliance initiatives and help improve policies, procedures, and workflows. Research, monitor, and stay current on all applicable regulatory changes, Medicaid updates, MCO requirements, state guidance, audit standards, and agency compliance obligations, and communicate any required operational changes to leadership and impacted departments. Ensure the agency is consistently prepared for audits, site visits, and documentation requests. Requirements Active RN license preferred. Minimum of 8-10 years of clinical, home care, home health, or related healthcare experience preferred. At least 5 years of management or supervisory experience required. Experience in home care, home health, Medicaid, MCO, or personal assistance services strongly preferred. Strong understanding of clinical documentation, Plans of Care, supervisory visits, caregiver compliance, quality assurance, and audit preparation. Experience with audits, investigations, corrective action plans, and regulatory compliance. Experience with HHAeXchange, WellSky/Kinnser, Axxess, or similar home care platforms preferred. Strong written communication skills, including the ability to prepare professional responses to MCOs and regulatory agencies. Ability to manage multiple deadlines, departments, and priorities. Strong leadership, organization, follow-up, and problem-solving skills. Must be comfortable working in an office-based leadership role with occasional field support as needed. Preferred Qualifications Experience working with Pennsylvania Medicaid/MCO programs. Experience preparing for MCO or state audits. Experience supervising QA staff, clinical staff, case managers, or field compliance teams. Experience handling complaints involving fraud, abuse, neglect, service concerns, or quality-of-care concerns. Multi-state home care compliance experience is a plus.

Compensation Salary Range:

$80,000 - $90,000 per year , based on experience. Compensation will be determined based on clinical experience, home care compliance background, leadership experience, and multi-state regulatory knowledge. Schedule Full-time position Office-based leadership role Occasional field visits may be required as needed for audits, investigations, supervisory visits, or quality concerns. Occasional travel to CareChoice operating states where the company has office locations may be required. About CareChoice Homecare CareChoice Homecare provides quality home care services to clients who need support in their homes. We are committed to compliance, accountability, caregiver support, and high-quality client care. We are looking for a strong RN leader who can bring structure, accountability, and compliance oversight to our Clinical and Quality Assurance operations. How to Apply Qualified candidates should submit their resume for consideration. We are looking for someone who is highly organized, experienced in home care compliance, and ready to take ownership of clinical quality and regulatory readiness across the agency.

Pay:

$80,000.00 - $90,000.00 per year

Benefits:

401(k) Dental insurance Health insurance Life insurance Paid time off Vision insurance

Work Location:

In person