Job Description

Position Summary

The Compliance Operations Leader is responsible for overseeing operational compliance, quality assurance, regulatory alignment, and training compliance for services within their assigned state(s). This role serves as a bridge between frontline operations, program leadership, quality management, HR, and executive leadership to ensure the organization maintains strong compliance practices while supporting efficient, person-centered service delivery.

This role is responsible not only for oversight and auditing, but also for proactively identifying operational risks, workflow inefficiencies, documentation concerns, training gaps, communication breakdowns, and systemic compliance vulnerabilities, and collaborating cross-functionally to resolve them.

The Compliance Operations Leader plays a key role in helping the organization scale responsibly while maintaining strong regulatory, operational, and quality standards across programs and departments.

Core Responsibilities

Regulatory & Operational Compliance Oversight

• Oversee ongoing compliance operations for assigned state programs and service lines.
• Ensure organizational practices remain aligned with applicable state regulations, Medicaid waiver requirements, payer expectations, licensing standards, and internal policies.
• Monitor operational compliance across documentation, service delivery, authorizations, staffing processes, incident management, and quality standards.
• Serve as a subject matter resource regarding compliance expectations and operational interpretation of regulations.
• Maintain awareness of regulatory updates and collaborate with leadership to operationalize changes into workflows, policies, training processes, and internal systems.
• Assist with licensing activities, audits, surveys, corrective action plans, and regulatory reviews as needed.
• Support organizational readiness for expansion into additional states, programs, and regulatory environments.

Documentation & Quality Assurance

• Oversee compliance auditing processes related to case notes, EVV alignment, service documentation, billing support documentation, and supporting records.
• Conduct routine audits and spot-check reviews to identify compliance concerns, documentation deficiencies, workflow breakdowns, and operational risks.
• Collaborate with Quality, Program, and Operations leadership to ensure documentation standards remain compliant, sustainable, and operationally effective.
• Monitor trends in documentation errors or recurring deficiencies and implement corrective action strategies.
• Support the development and refinement of documentation standards, QA tools, templates, audit processes, and workflow guidance.
• Ensure documentation workflows support billing integrity, audit readiness, and reduction of organizational risk exposure.
• Assist departments with understanding and implementing documentation expectations and quality standards.

Training Compliance Oversight

• Oversee organizational compliance related to required staff trainings, onboarding requirements, certifications, annual renewals, and ongoing competency expectations.
• Assign required trainings to staff based on role, program, service line, and regulatory requirements.
• Monitor training completion status and ensure staff remain current on all mandatory trainings and compliance requirements.
• Maintain systems and processes for tracking onboarding trainings, annual recertifications, competency requirements, and expiring credentials.
• Collaborate with HR, Program Leadership, Clinical teams, and supervisors to ensure training assignments align with operational and regulatory expectations.
• Follow up proactively with staff and supervisors regarding overdue, incomplete, or expiring trainings and certifications.
• Assist with preparation for audits, licensing reviews, and regulatory requests related to staff training compliance.
• Help develop scalable systems, workflows, reminders, and tracking processes to strengthen ongoing training compliance across the organization.
• Support the organization and development of onboarding materials, compliance education tools, training resources, and staff guidance documentation.
• Identify recurring training gaps or operational trends and collaborate with leadership on corrective action and educational initiatives.

Incident Management & Risk Oversight

• Oversee operational compliance related to incident reporting, escalation procedures, and required follow-up activities.
• Ensure reportable incidents are escalated, documented, investigated, and resolved within required timelines and according to applicable regulations.
• Collaborate with Quality and Program leadership on root-cause analysis, corrective action planning, and risk mitigation initiatives.
• Identify systemic operational risks and proactively recommend process improvements to reduce compliance exposure and improve service quality.
• Assist in monitoring implementation of corrective actions and ongoing compliance follow-through.

Operational Process Improvement

• Identify inefficiencies, workflow gaps, communication breakdowns, or operational practices that may create compliance risk or negatively impact service quality.
• Collaborate with leadership, including Program Leadership, Operations, Quality, Billing, HR, Clinical, and Executive teams, to design stronger operational structures and workflows.
• Assist in developing scalable operational systems that support organizational growth while maintaining compliance integrity.
• Participate in implementation and optimization of operational platforms, EHR systems, EVV workflows, authorization tracking systems, QA infrastructure, and compliance monitoring processes.
• Help ensure operational workflows are realistic, sustainable, clearly communicated, and consistently executed across departments.
• Support the creation of internal process guides, templates, workflow documents, compliance resources, and operational support tools.

Cross-Departmental Leadership & Collaboration

• Work collaboratively with Program Leadership, State Supervisors, Case Management Leadership, Quality, Billing, HR, Clinical teams, and Executive Leadership.
• Participate in operational meetings, compliance review discussions, and quality improvement initiatives.
• Assist leadership in balancing regulatory requirements with operational realities and person-centered service delivery.
• Help foster a culture of accountability, operational excellence, responsiveness, and continuous improvement.
• Support departments in resolving operational concerns while maintaining compliance expectations and organizational standards.

Qualifications

• Experience in healthcare, behavioral health, IDD services, home/community-based services, Medicaid waiver programs, or another highly regulated environment.
• Experience in PA ODP/ NJ DD/ NY OPWDD Community Based Supports or similar preferred
• Strong understanding of operational compliance, quality assurance processes, and regulatory frameworks.
• Experience with audits, documentation review, incident management, training compliance, operational workflow development, or Medicaid compliance strongly preferred.
• Strong organizational, analytical, problem-solving, and follow-through skills.
• Ability to identify operational risks while maintaining collaborative and solution-oriented working relationships.
• Strong written and verbal communication skills.
• Experience working with EHR, EVV, HR, billing, payroll, training, or operational management systems preferred.
• Ability to manage multiple priorities in a fast-paced, growing organization.

Preferred Characteristics

• Highly detail-oriented with strong operational judgment.
• Able to balance compliance rigor with practical operational implementation.
• Proactive, organized, and process-minded.
• Strong emotional intelligence and professionalism.
• Collaborative, team-player, friendly, and personable.
• Comfortable navigating complex operational and regulatory environments.
• Solutions-oriented with strong accountability and follow-through.
• Able to lead through collaboration, structure, support, and operational oversight.

Skills Required

Experience Required

3-4 years