Program Integrity Quality Specialist

Overview

Join Our Impactful Team at Health Connect America! 

Before you get started on your journey with Health Connect America, take some time to learn more about us. At Health Connect America, all services are guided by a unified, trauma-informed approach.  Across every program, we are committed to providing compassionate, client-centered care that fosters healing and growth. Our services are delivered by clinically trained staff, grounded in a therapeutic mindset and informed by research and evidence-based practices at every level of care.   Health Connect America and its affiliate brands are leaders in providing mental and behavioral health services to children, families, and adults across the nation.  We provide our services directly to those in need whether that be within a person's home, their community, or in one of our office settings.  Health Connect America is honored to be a part of the communities we serve and the clients we walk alongside as they embark on a journey to self-improvement and more fulfilling lives.   At Health Connect America, we are dedicated to making meaningful connections every day through creating quality, affordable opportunities for individuals and families to achieve their greatest potential in a safe, positive living environment. 

Come make a difference and grow with us!

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Responsibilities

The Program Integrity & Quality Specialist is responsible for ensuring both the compliance and effectiveness of organizational practices across all programs. This role conducts comprehensive reviews to verify adherence to licensing, payor, and COA accreditation standards, while also assessing the quality-of-service delivery.

Responsibilities include evaluating documentation for regulatory compliance and best practice standards, validating staff credentialing and service alignment, and monitoring for indicators of fraud, waste, or abuse. Beyond compliance, the Specialist supports continuous quality improvement by conducting client quality assurance calls, analyzing feedback to identify trends, and collaborating with leadership to develop and implement improvement strategies that enhance service outcomes and client satisfaction.

• Conduct comprehensive compliance and quality reviews across all programs and states to ensure organizational adherence to regulatory, payor, and accreditation standards while promoting continuous improvement in service delivery.

• • Client Chart Reviews:Evaluate clinical records for compliance with licensing, Medicaid, and COA standards. Verify documentation accuracy, completeness, and clinical appropriateness, ensuring that services are delivered by properly credentialed and qualified staff.
  • Quality Assurance Calls:Contact a representative sample of clients to assess satisfaction, service quality, accessibility, outcomes, and client rights. Identify and report potential concerns related to service effectiveness or resource integrity.
  • Administrative Process Reviews:Partner with the Implementation and Development team to evaluate key operational processes—including training completion, clinical supervision practices, contract deliverables, licensing documentation, fidelity monitoring, policy and procedure updates, and incident reporting, for compliance, quality, and timeliness.

• Apply standardized tools and review checklists to ensure objectivity, consistency, and accuracy across all program integrity and quality assessments.
• Analyze and interpret review results to identify trends, patterns, risks, and opportunities for improvement at the state, program, and enterprise levels.
• Communicate findings through comprehensive, actionable reports and dashboards, providing clear recommendations for corrective actions, ongoing monitoring, and continuous improvement initiatives.
• Actively participate in collaboration with Operations and other cross-functional teams to help inform and support the development of structured site support plans, performance improvement strategies, and follow-up reviews addressing identified gaps.
• Develop, update, and refine review tools and methodologies for existing and newly acquired programs, ensuring alignment with company standards and regulatory requirements.
• Support Program Integrity and Oversight activities as needed, including assisting with external payor audits, state reviews, or accreditation-related inquiries by gathering documentation, verifying compliance evidence, and coordinating responses to ensure timely and accurate submissions.
• Support Quality and Accreditation activities, particularly during the organization’s reaccreditation cycle, by assisting with file reviews, documentation verification, and preparation for site visits to ensure alignment with COA standards and organizational policies.
• Maintain strong professional relationships with internal stakeholders, exercising sound judgment and discretion when managing sensitive information.
• Develop and maintain a strong understanding of payor and licensing regulations, including documentation, billing, and service delivery requirements, to ensure accurate and compliant program reviews and recommendations.
• Ensure full compliance with HIPAA, confidentiality, and ethical standards in all activities.
• Demonstrate independence and professional expertise through strong critical thinking, analytical, and decision-making skills that support both program integrity and quality improvement objectives.

Qualifications

• Candidate must hold a minimum of a bachelor’s degree and possess at least five (5) years of professional experience in behavioral health or human services. Prior experience in program integrity, compliance, or quality management is preferred.
• Internal candidates preferred.

Be Well with HCA: 

• We recognize the importance of self-care and work/life balance. 

• We offer flexibility in scheduling and provide all employees access to our Employee Assistance Program (EAP), which includes 8 mental health counseling sessions annually. 

• Full-time HCA employees enjoy paid time off, paid holidays, and a comprehensive benefits package that includes medical, dental, vision, and other voluntary insurance products. 

• Additional benefits include: 

• Access to a Health Navigator 

• Health Savings Account with company contribution 

• Dependent Daycare Flexible Spending Account 

• Health Reimbursement Account 

• 401(k) Retirement Plan 

• Benefits Hub 

• Tickets at Work 

Join a team where your contributions truly make a difference in the lives of others. Apply now to be part of our dynamic and supportive community at Health Connect America! 

Employment at Health Connect America and its companies is contingent upon meeting the requirements of a comprehensive background investigation prior to joining our team. 

Health Connect America and its companies are an Equal Opportunity Employer and consider applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics, or any other basis forbidden under federal, state, or local law.  For more information on Equal Opportunity, please click here Equal Employment Opportunity Posters