Quality and Control Manager - Licensure & Enrollment

Our Company

BrightSpring Health Services

Overview

Lead with Precision. Drive Compliance. Make an Impact.

Are you a strategic, detail-driven leader who thrives at the intersection of healthcare regulation, quality assurance, and operational excellence? Join the Legal Department of a national, publicly traded healthcare company as Quality and Control Manager, Licensure & Enrollment and play a pivotal role in protecting the organization’s regulatory standing, strengthening compliance, and driving continuous improvement across its provider and pharmacy businesses.

In this high-impact role, you’ll lead the development and evolution of a comprehensive quality control program overseeing Medicare and Medicaid enrollments and healthcare business and service licenses. You’ll transform complex regulatory requirements into effective controls, reliable processes, and actionable insights—helping ensure critical licenses and enrollments remain accurate, current, and compliant across multiple jurisdictions.

Working collaboratively with Legal, operations, revenue cycle, finance, provider and pharmacy teams, and state and federal agencies, you’ll identify risks before they become issues, strengthen oversight of critical deadlines, and champion solutions that improve accuracy, accountability, and efficiency. You’ll also establish standardized quality control methodologies, enhance reporting and database integrity, lead corrective action initiatives, and help build a scalable framework that supports the company’s continued growth.

This is an opportunity to make a meaningful difference: safeguard business continuity, reduce regulatory and financial risk, elevate operational performance, and shape a quality control function built for long-term success.

If you bring deep healthcare licensure or enrollment experience, exceptional organizational skills, sound judgment, and a passion for turning complex requirements into measurable results, we invite you to bring your expertise and leadership to a role where precision matters and your impact reaches across the enterprise.

Responsibilities

·       Oversee ongoing quality control reviews of active and upcoming enrollments and licenses to confirm that renewals, revalidations, and other required changes are accurately tracked and completed within required timeframes.

·       Direct the development and maintenance of complete inventories of active and upcoming enrollments and licenses subject to quality control review.

·       Partner with Licensure & Enrollment team, revenue cycle, provider and pharmacy contracting, and state and federal agencies to oversee monitoring of renewal, revalidation, expiration, and other applicable due dates to confirm they are            accurately recorded, tracked, and completed within required timeframes.

·       Identify and implement a process to detect and address off-cycle recredentialing requests before credentials lapse.

·       Lead quality control reviews of enrollment and license records, agency correspondence, renewal calendars, alerts, approval records, and retention records to confirm accuracy, completeness, and compliance.

·       Ensure changes to business or service licenses are appropriately evaluated for potential impact on Medicare and Medicaid enrollments and business and service licenses.

·       Serve as a primary point of contact with state and federal agencies to clarify requirements, verify status, obtain supporting information, and resolve quality control questions or discrepancies.

·       Evaluate quality control results against internal license management policies and procedures, applicable regulatory requirements, and financial controls governing enrollment and license payments and renewals.

·       Identify missed or expired licenses, late renewals or revalidations, inaccurate or incomplete records, and control weaknesses; escalate material risks and drive timely resolution.

·       Prepare and present quality control reports that clearly document observations, risk levels, supporting evidence, and actionable recommendations for leadership.

·       Lead development of management action plans, assign remediation owners and target dates, and confirm completion of corrective actions.

·       Identify control weaknesses and process gaps and lead the development and implementation of corrective action plans that reduce compliance, operational, and financial risk.

·       Establish standardized quality control methodology, documentation standards, checklists, and reporting tools, and identify opportunities for automation and process improvement.

·       Provide guidance, training, and quality oversight to team members supporting the quality control function.

·       Maintain a high level of confidentiality while handling sensitive legal, regulatory, provider, patient, financial, and business information.

·       Responsible for all aspects of the licensure and enrollment database, including working with business lines to ensure all licenses and enrollments are maintained in the database.

·       Strengthen governance, standardize quality control methodology, and build a scalable quality control function.

Qualifications

EDUCATION/EXPERIENCE

·       Bachelor’s degree in business, healthcare administration, accounting, legal studies, compliance, or a related field required; advanced degree (e.g., MBA, MHA, JD) preferred.

·       Minimum five years of relevant experience in healthcare licensure, Medicare or Medicaid provider enrollment, pharmacy enrollment, quality control, compliance, or regulatory operations, multi-state healthcare experience strongly preferred.

LICENSE/CERTIFICATION/OTHER SPECIAL REQUIREMENTS

·       Certified Manager (CM), Certified in Healthcare Compliance (CHC), Lean Six Sigma Black Belt, or similar quality management or compliance certification preferred but not required.

KNOWLEDGE/SKILLS/ABILITIES

·       Strong working knowledge of Medicare and Medicaid enrollment, healthcare business and service licensing, renewals, revalidations, and related regulatory requirements.

·       Demonstrated ability to design, implement, and lead a quality control or compliance program, including standardized methodology, controls testing, and continuous monitoring.

·       Exceptional organization and attention to detail, with the ability to manage multiple quality control workstreams, records, deadlines, and follow-up actions.

·       Excellent written and verbal communication skills, including the ability to present findings and recommendations clearly to leadership, business partners, and state and federal agencies.

·       Ability to prepare clear quality control documentation, findings, risk assessments, recommendations, and status reports supported by appropriate evidence.

·       Advanced proficiency with Microsoft Office, particularly Excel.

·       Experience using databases, workflow tools, dashboards, or other tracking systems.

·       Proven leadership, coaching, and people-management skills, with the ability to guide and develop staff supporting the quality control function.

·       Comfort working with governmental agencies and interpreting or applying regulatory requirements to license and enrollment records.

·       Strong judgment, professional skepticism, problem-solving ability, and a consistent commitment to accuracy and continuous improvement.

·       Ability to collaborate across Legal, revenue cycle, finance, operations, provider, and pharmacy functions and influence outcomes without direct authority when needed.

·       Ability to maintain confidentiality of sensitive legal, regulatory, provider, patient, financial, and business information.

TRAVEL REQUIREMENTS

Percentage of Travel:  0-10%

  

About our Line of Business

BrightSpring Health Services provides complementary home- and community-based health solutions for medically complex populations in need of specialized and/or chronic care. Through the Company’s service lines, including pharmacy, home health care, and rehabilitation, we provide comprehensive and more integrated care and clinical solutions in all 50 states to approximately 500,000 customers, clients and patients daily. BrightSpring has consistently demonstrated strong and industry-leading quality metrics across its services lines, while improving the health and quality of life for high-need individuals and reducing overall healthcare system costs. For more information, please visit www.brightspringhealth.com. Follow us on Facebook, LinkedIn, and X.