Operations and QA Manager

Overview We are seeking a dynamic and detail-oriented Operations and Quality Assurance (QA) Manager. This role oversees the administrative and operational infrastructure of the program, with a focus on revenue cycle integrity, insurance tracking, compliance, and quality assurance. The position is responsible for ensuring that non-clinical systems and workflows run efficiently, ethically, and in alignment with regulatory and accreditation standards. This role serves as a key bridge between clinical, financial, and administrative functions—supporting accurate reimbursement, strong documentation practices, and overall operational consistency. Additionally, the position supports leadership through reporting, process improvement, and oversight of critical systems that impact both financial performance and quality of care. Essential Duties and Responsibilities Insurance & Reimbursement Oversight Provide supervision, guidance and support to internal staff coordinating insurance authorization, billing and financial collection Oversee insurance workflows, including authorizations, billing coordination, single case agreements, rate negotiations and reimbursement tracking Act as a liaison between internal CW staff and our billing company, Malibu Group as needed or when complications arise Troubleshoot complex payer issues, including denials, delays, and underpayments Manage and support appeals process (including clinical appeals, higher reimbursement appeals, submissions to the California Department of Managed Health Care (DMHC)) Review reimbursement logs to ensure accuracy of payments and client disbursements Communicate with families as needed regarding insurance status and reimbursement timelines, especially when there are challenges and issues Compliance & Regulatory Oversight Ensure adherence to The Joint Commission standards and applicable regulatory requirements Conduct routine chart audits to verify completeness, accuracy, and timeliness of documentation Follow up with staff on incomplete or missing documentation and ensure timely resolution Maintain and update policies, procedures, and documentation standards in alignment with The Joint Commission accreditation requirements Support audit readiness and coordinate preparation for accreditation reviews and site visits Quality Assurance (QA) Review clinical and administrative documentation for quality, consistency, and adherence to internal standards Identify trends, gaps, and areas for improvement across documentation and workflows Provide feedback to staff and leadership to improve accuracy and consistency Develop and implement QA processes to strengthen documentation and operational effectiveness Collaborate with clinical and administrative teams to support ongoing quality improvement initiatives Non-Clinical Training & Team Support Manage Kipu systems, adding new products and services where appropriate Supervise administrative and/or operations staff as applicable Implement and train team members on workflows, compliance, and tracking systems Act as a bridge between admissions, clinical, and billing teams Core Competencies Insurance & Revenue Cycle Proficiency Solid working knowledge of insurance processes, utilization review, and reimbursement workflows; able to manage issues and support appeals, including escalations to entities like the California Department of Managed Health Care Compliance Execution and Quality Assurance Familiarity with accreditation standards (including The Joint Commission) and ability to ensure day-to-day compliance through audits and follow-up. Able to independently conduct chart reviews, identify documentation gaps, and drive timely resolution with staff Data & Financial Accuracy Comfortable reviewing reimbursement data, identifying discrepancies, and ensuring accuracy in tracking and reporting Professional Communication Clear, direct communicator with the ability to navigate sensitive conversations with families and collaborate across teams Team Support & Accountability Capable of supervising or guiding administrative staff and reinforcing expectations around workflows and deadlines

Physical Demands:

The employee is regularly required to sit and talk or hear. The employee is frequently required to stand, use hands to handle paperwork and computer work, reach with hands and arms. The employee is additionally required to walk and travel between work locations.

OTHER:

Equipment used: computer, phone, and other office equipment as needed

Access:

stair, elevator Varies, typically M - F, on-call hours Equal Employment Opportunity Community West is an equal opportunity employer and considers all qualified applicants without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, age, disability, or any other status protected by applicable law.

Pay:

$75,000.00 - $90,000.00 per year

Benefits:

Dental insurance Health insurance Paid time off Vision insurance

Work Location:

In person