Quality Improvement & Compliance Manager

Quality Improvement & Compliance Manager

Alhambra, CA

About Seen Health

At Seen Health, we are revolutionizing the way senior care is delivered through the PACE (Programs of All-Inclusive Care for the Elderly) model. Backed by top VCs, Seen Health is a culturally-focused, technology-enabled healthcare organization that integrates comprehensive medical care and social support with a high-touch, interdisciplinary approach.

Our mission is to empower seniors to age-in-place with dignity and provide their families peace of mind. We are building upon a proven Home and community based services model to create a culturally-competent and scalable PACE program. We are also building a comprehensive operating system focused on data and workflows that span across systems, processes, people, and care contexts. We want to empower our clinicians and staff with tools that deliver relevant data at the time and site of care and enable them to deliver exceptional care to our participants, which improve clinical outcomes, participant & provider satisfaction, and ultimately our strength as an organization.

We are a mission-driven, multidisciplinary team with deep healthcare, technology, and operations expertise, each inspired by our own personal stories of caring for seniors in our lives. Our name, Seen Health, was chosen to reflect our commitment to provide the highest standard of care to underserved older adults while respecting and incorporating their individual beliefs, heritage, and values, so that they can truly be seen.

About the Role

The Quality Improvement & Compliance (QIC) Manager translates Seen Health's quality and compliance strategy into reliable day-to-day execution. This role identifies and investigates compliance risk, ensures participant concerns are thoroughly evaluated, manages regulatory monitoring and corrective action, and drives deficiencies to sustainable resolution. The Manager serves as the Director's primary operational partner, independently managing routine and moderately complex quality and compliance matters while escalating significant organizational risk.

Responsibilities

Quality & Compliance Monitoring

• Execute the annual QIC monitoring and audit plan; conduct or assign targeted audits
• Review findings for severity, frequency, regulatory exposure, and participant impact; track corrective actions through verified closure
• Escalate material or repeat deficiencies to the QIC Director

Grievance Investigation & Administration

• Own grievance administration: confirm classification, lead fact-finding and interviews, evaluate evidence, and ensure written resolutions are complete and appropriate
• Track remedies and corrective actions; review trends for systemic issues and escalate significant participant-rights or regulatory concerns

Regulatory Compliance

• Translate CMS, DHCS, and other regulatory requirements into monitoring tools and crosswalks
• Conduct compliance reviews and support departments in interpreting and implementing requirements
• Escalate unresolved regulatory risk

Corrective Action Management

• Ensure CAPs identify root cause, corrective action, owner, due date, monitoring methodology, and effectiveness evidence
• Reopen or revise CAPs that don't demonstrate effectiveness

Regulatory Readiness

• Coordinate internal audit readiness, maintain evidence repositories, conduct mock reviews, and support CMS/DHCS audits

Team Supervision

• Directly supervise the QIC Coordinator: assign priorities, review work quality, coach performance, and build technical competency

Quality Improvement Oversight

• Review dashboards and trends, support PIPs, and ensure improvement actions have accountable owners

AI-Enabled QIC Operations

• Identify QIC workflows suited for AI/automation; validate that automated monitoring accurately detects what it's designed to catch
• Review AI-generated findings for accuracy before incorporating into audits, investigations, or compliance conclusions
• Ensure staff apply professional judgment rather than relying on AI output alone

Qualifications

• Bachelor's degree in healthcare administration, public health, nursing, quality, business, or related field (equivalent substantial experience considered)
• 4+ years of healthcare quality, compliance, regulatory, managed-care, or clinical operations experience
• Experience conducting audits or investigations, and managing corrective actions and regulatory deadlines
• Supervisory, project leadership, or team-lead experience
• Professional verbal fluency in Mandarin required, sufficient to independently conduct participant/caregiver interviews and investigate grievances; Cantonese preferred
• PACE experience, CMS/DHCS regulatory experience, grievance/appeals/participant-rights investigation experience, and a clinical license or quality/compliance certification are all preferred

Location

• Los Angeles required. Ability to commute to Alhambra required.
• Relocation benefits available.

Salary & Benefits

• Salary: $120,000 $150,000 per year, depending on experience
• Equity: included as part of founding team package
• Benefits: Seen Health is proud to offer a robust benefits offering for our employees. In addition to traditional healthcare coverage, we also offer additional benefits to help further your wellness and feeling of being part of the team.
• Medical, Dental, and Vision benefits for you and your family
• Life Insurance and Disability Benefits
• Parental and Caregiver Leave
• Lunch, as well as delicious snacks and coffee to keep you energized
• Paid Time Off across holidays, vacation time, personal days, and sick days
• 401k Plan
• Personal and professional development, including CME support and career growth opportunities
• Subscriptions and training on using AI tools including ChatGPT