Director of Payer Compliance & Quality Assurance

Job description

Overview Salary: $120,000 - $130,000 as year (DOE) On-Site Position: The Director of Payer Compliance & Quality Assurance is a senior leadership role responsible for strengthening organizational compliance, quality, and revenue integrity across all levels of care , including PHP, IOP, OP, Residential, and Adolescent Services . This role provides strategic oversight and hands‑on leadership in the development, implementation, and continuous monitoring of payer‑specific compliance frameworks , ensuring alignment with state regulations, accreditation standards (Joint Commission, CARF), and payer medical necessity requirements . Responsibilities: - Lead organization‑wide payer compliance strategy across all levels of care (PHP, IOP, OP, Residential—Adult & Adolescent) - Interpret payer policies, medical necessity criteria, state regulations, and accreditation standards (Joint Commission, CARF) - Develop and maintain payer compliance crosswalks aligned to payer, regulatory, and accreditation requirements - Design and oversee a company‑wide QA and payer compliance audit program - Audit clinical documentation, utilization review records, and medical necessity support to ensure payer readin...