Director of Quality and Compliance (Healthcare)

Description

Be Part of Something Radically Different

At Holon Health, we don’t do “business as usual.” We’re a trailblazing healthcare startup reimagining what it means to care, for our clients and our people. We provide whole-person care to justice-involved individuals living with Substance Use Disorder (SUD), and we do it with deep compassion, community wisdom, and an unshakable belief in second chances.

Our approach throws out the playbook. We integrate medical, behavioral, and social care. We prioritize prevention and recovery. We treat clients like people, not checkboxes. And just as importantly, we know that our team can only care for others if they’re cared for themselves. That’s why we lead with flexibility, trust, and a culture built on well-being, inclusion, and respect.

If you’re energized by meaningful work and want to feel good about how you spend your days, read on.

About the Role

We’re hiring a Director of Quality and Compliance to be the single owner of quality assurance and compliance operations across every state Medicaid program and health plan we work with.

In practice, that means you own our standard operating procedures (SOPs). You receive, review, and manage every incident and its external reporting deadlines. You lead root cause analysis and corrective action, run internal audits, train staff, and track regulatory change across states and plans. You report into our Chief Clinical Officer, partner closely with Operations and Product Development, and serve as secretariat to our Health Equity and Quality Metrics Committee (HEQMC).

You’ll also be the business owner of our incident management platform, partnering with Product Development to turn approved requirements into workflows, so care is delivered consistently everywhere we operate.

This role involves regular contact with reports of incidents, serious injury, death, and suspected abuse, neglect, or exploitation. We include that here so you have it before you apply. You won’t carry it alone. Our Medical Director serves as clinical consultant on root cause analyses, sentinel events escalate to the Medical Director and CEO, and we take self-care seriously here.

What You’ll Do

Own our SOPs and document control

Own every Holon SOP, including state and health plan addenda. Run the annual review of each one, plus out-of-cycle updates when a regulation or plan contract changes.

Maintain document control: version numbering, approval routing to the HEQMC, effective dates, revision history, retirement of superseded versions, and a controlled index.

Define the compliance requirements, supporting regulatory or contractual sources, and acceptance criteria for controls built into our platform. Product Development owns technical design, implementation, delivery planning, and release.

Manage incidents end to end

Receive, triage, review, and manage every incident, accident, death, and report of suspected abuse, neglect, or exploitation.

Determine reportability for each member’s state and health plan, file external reports to agencies and plans within the strictest applicable deadline, and record confirmation numbers.

Track follow-up reports, returned reports, and closure. Escalate sentinel events and deaths to the Medical Director and CEO.

Maintain the incident rules table and abuse hotline directory (destinations, deadlines, forms, numbers) under an approved change control process, working with Product on any change that affects application logic, automated actions, access, or established workflows.

Make sure mandated reporter obligations are met and documented for every abuse, neglect, or exploitation concern.

Lead root cause analysis and corrective action

Lead root cause analyses (5 Whys, fishbone) for sentinel and critical events, and other incidents as needed, with the Medical Director as clinical consultant. Complete within 30 days.

Build corrective and preventive action plans with named owners, due dates, and effectiveness measures. Present them to the HEQMC and track them to verified completion.

Run internal audits and monitoring

Plan and run internal audits covering chart documentation, billing documentation, Collaborative Care (CoCM) and Remote Therapeutic Monitoring (RTM) time and activity records, and consent and telehealth documentation.

Report findings, root causes, and corrective actions. Track findings to closure and re-audit to confirm the fix held.

Coordinate with revenue cycle on pre-bill review findings and refunds of identified overpayments.

Train and support our teams

Partner with our clinical trainer on all SOP training for new hires and annual refreshers, including incident reporting and mandated reporting. Run competency checks and maintain training records.

Brief staff on SOP changes and state or plan rule changes before they take effect.

Check technology dependencies with Product Development before approving SOP changes or commitments that require platform modifications, and identify interim operational controls when an obligation lands before software can be delivered.

Manage payer and regulatory relationships

Prepare and submit responses to health plan quality of care (QOC) inquiries, audits, record requests, and corrective action requests within payer deadlines.

Monitor regulatory and contract change across states and plans, including state Medicaid policy, health plan provider manuals, CMS rules, and privacy rules. Assess impact and update SOPs, addenda, and platform rules.

Maintain state and health plan reporting portal accounts, each with a named backup user.

Support the HEQMC and our accreditation work

Serve as secretariat to the HEQMC: agendas, minutes, action logs, SOP approvals, and the quarterly quality pack.

Report incident trends, on-time reporting rates, audit results, corrective action status, training completion, and equity patterns to the HEQMC and CEO.

Support NCQA Health Equity Accreditation readiness, including evidence collection, policy alignment, data stratification by language and demographics, and survey preparation.

Other duties as assigned.

Requirements

What You’ll Bring

We welcome candidates from a clinical, compliance, or operations management background. Training and experience in operations management, process improvement (Lean, Six Sigma), or quality management counts as equivalent to a clinical or compliance background for this role.

One of the following: a clinical license (for example RN, LCSW, LPC); a bachelor’s degree in a health-related field such as health administration, public health, or nursing; or a bachelor’s degree in business, operations management, industrial engineering, or a related field, or equivalent formal training in operations management, process improvement, or quality management.

7+ years of experience in one or more of: healthcare quality, compliance, risk management, or accreditation; operations management; or process improvement and quality management. Healthcare is preferred, and experience in another regulated industry is considered.

Multistate compliance experience: tracking and applying differing state and health plan rules, and applying the strictest one.

Experience with regulatory reporting and compliance, for example Medicaid managed care, state and health plan regulatory reporting, or comparable reporting in another regulated setting.

Experience with incident or event management, including leading root cause analyses and corrective action plans.

Experience writing and maintaining SOPs and training staff on them.

Strong writing skills, specifically clear procedures, regulatory responses, and committee reports.

Working knowledge of the HIPAA Privacy and Security Rules and 42 CFR Part 2 (confidentiality of substance use disorder records).

Comfort working in EHR or app-based workflows, with dashboards and spreadsheets.

Bonus Points if You Have

Certified in Healthcare Compliance (CHC),