Clinical Compliance Manager

The Compliance Manager is responsible for developing, implementing, and monitoring programs that ensure the agency operates in full compliance with all applicable state and federal regulations, accreditation standards, and internal policies. This role focuses on protecting client safety, maintaining regulatory readiness, and fostering a culture of ethical practice while supporting the agency’s operational and service excellence. In a private-pay environment, the Compliance Manager will adapt best practices from Medicare / Medicaid compliance frameworks while ensuring tailored procedures that meet the expectations of self-pay clients and California’s licensing requirements.

Key Responsibilities :

Regulatory & Licensing Compliance

• Lead preparation for California Department of Public Health (CDPH) surveys, state licensing renewals, and other regulatory audits.
• Monitor ongoing staff licensure and credential compliance (RN, PT, OT, HHA, etc.), including TB testing, health screenings, CPR certifications, and mandatory training per Title 22 and agency policy.
• Maintain a compliance calendar to track renewal deadlines, required filings, and mandatory reporting.
• Ensure HIPAA compliance and oversee internal privacy / security audits.

Compliance Program Oversight

• Develop, update, and enforce policies and procedures that reflect state regulations, agency standards, and private-pay client needs.
• Conduct internal audits to assess operational compliance, identifying gaps and implementing corrective action plans.
• Serve as the agency’s designated Compliance Officer for risk management and incident reporting.

QAPI Leadership

• Develop, implement, and oversee the agency’s QAPI program in accordance with California Title 22 and industry best practices.
• Coordinate quarterly QAPI committee meetings, including agenda preparation, data presentation, and documentation of meeting minutes.
• Collect, track, and analyze performance data (e.g., clinical outcomes, client satisfaction, incident trends, infection control statistics).
• Identify opportunities for improvement, develop performance improvement projects (PIPs), and monitor progress to completion.
• Ensure QAPI findings are communicated to leadership and staff, with education provided as needed to support improvement initiatives.
• Maintain all QAPI-related documentation for regulatory review and agency records.

Clinical Compliance Oversight

• Partner with the Director of Nursing and clinical supervisors to ensure that all patient care meets regulatory, safety, and quality standards.
• Review clinical documentation for accuracy, timeliness, and adherence to care plans and physician orders.
• Monitor compliance with infection control protocols, medication administration procedures, and patient safety guidelines.
• Audit clinical charts regularly to verify proper documentation, plan-of-care updates, and alignment with agency protocols.
• Provide guidance to clinical teams on regulatory requirements and participate in clinical competency evaluations.
• Ensure corrective action plans are developed and implemented for any deficiencies identified in clinical practice.

Staff Training & Education

• Provide compliance orientation for new hires and ongoing education for current staff.
• Distribute policy updates, conduct annual training, and maintain training records in the EMR system.

Incident Management & Reporting

• Receive, investigate, and document reports of non-compliance, safety incidents, or client complaints.
• Coordinate corrective actions and follow-up monitoring.
• Prepare required notifications to state agencies or accrediting bodies.

Operational Support & Coordination

• Collaborate with recruiting, HR, and clinical teams to ensure compliance considerations are built into hiring, onboarding, and performance evaluations.
• Oversee documentation standards for patient intake, care plans, and service records to ensure they meet state requirements and agency policy.

Audit & Survey Readiness

• Maintain organized records for all audits, including employee files, client records, and compliance reports.
• Host auditors and surveyors, responding to inquiries and providing documentation.

Qualifications :

• Bachelor’s degree in Healthcare Administration, Nursing, or related field (Associate degree with equivalent experience considered).
• Minimum 3–5 years in healthcare compliance, preferably in home health or related field.
• Deep knowledge of California home health regulations, HIPAA, and best practices in private-pay service delivery.
• Strong organizational, communication, and leadership skills.
• Proficiency in Microsoft Office Suite, EMR systems, and credential management tools.
• Ability to manage sensitive information with discretion and integrity.

Key Competencies :

• Detail-oriented with strong analytical and problem-solving abilities.
• Ability to work independently and manage multiple priorities in a fast-paced environment.
• Excellent interpersonal skills to engage with staff, leadership, and regulatory bodies.