Quality and Control Manager, Licensure & Enrollment

* 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.