Quality Improvement & Risk Manager/Compliance Officer

Quality Improvement & Risk Manager/Compliance Officer 3.7 3.7 out of 5 stars Tyler, TX 75703 Hybrid work Full-time New Era 121 reviews Full-time A unique leadership opportunity is available within a premier Mental Health & Substance Abuse Rehabilitation organization serving Texas and Louisiana. We are seeking a Quality Improvement & Risk Manager / Compliance Officer to lead regulatory compliance, quality assurance, and risk management initiatives while ensuring the highest standards of client care. This role is ideal for a self-driven, patient-focused professional who thrives independently while collaborating within a supportive, mission-driven team. The selected candidate will play a critical role in driving operational excellence, improving clinical outcomes, and maintaining strict adherence to internal, state, and federal regulations. Major Responsibilities / Duties /

Critical Tasks:

Review and audit internal client records, and staff records against company, state and federal regulations regularly. Prepare external audits to insurance payers, regulatory officials or state programs for review. Lead the organization in preparing for inspections and audits, ensuring all stakeholders are aware of regulatory requirements. Implement and manage an effective compliance program. Develop, implement and review company policies such as SOPs. Advise management on the company's compliance with state and federal regulations through reporting methods. Create and manage effective action plans in response to audit discoveries and compliance violations. Act as a liaison with regulatory agencies, accreditation bodies, and payor representatives, ensuring that the organization's quality and compliance initiatives meet regulatory standards and prioritize diverse and underserved populations. Regularly conduct internal and external audit of company procedures, practices, and documents to identify possible weaknesses or risks. Maintain accurate documentation of all compliance activities, audits, assessments, and quality improvement initiatives, with an emphasis on promoting transparency, equity, and accountability. Assess company operations to determine compliance risk. Partner with other teams to ensure data quality through sequential transformations and identify opportunities to close quality and risk care gaps. Function as a member of an interdisciplinary team. Efficiently and effectively interact with team members. Ensure all employees are educated on the latest regulations and processes. Ensure staff are up to date on all certifications, training and licensures Oversees the dissemination and collection of client satisfaction surveys. Proactively communicate risks and issues to stakeholders and leadership. Create, review, and approve program documentation, including plans, reports, and records. Proactively communicate regular status reports to stakeholders, highlighting progress, risks, and issues Use excellent oral and written communication skills. Participate in regular team meetings. Handle confidential and/or sensitive information with discretion and adherence to HIPAA rules Promote the NETCC mission, vision, and values by action Other duties as assigned. Required Education /

Experience:

Preferably have at least six (6) years in healthcare field with expierence with quality assurance, utilization review, or similar work., program and/or project management experience in risk adjustment and/or quality improvement on a health insurance, state or federal level. Bachelor's degree or equivalent required combination of education and experience. This role reports directly to the Executive Officer and Chief Officers, serving as a key partner to executive leadership on compliance, risk, and quality initiatives. This position will be Remote with required occasional travel for audits and on-site reviews in Texas and Louisiana The ideal professional should be passionate with expertise in healthcare compliance, risk mitigation, and quality improvement, who is passionate about ensuring patient safety and operational excellence Compensation is dependent upon experience.