Quality and Control Manager, Licensure & Enrollment
Job 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
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About Us
Notice of Use of Artificial Intelligence Tools in the Recruitment Process
At BrightSpring Health Services, our LEGACY culture guides how we lead, how we serve, and how we show up for one another. We are committed to doing the right thing by leading with integrity, accountability, and transparency in all that we do.
As part of our hiring process, we may use third-party artificial intelligence (AI) tools to assist in processing employment-related information. These tools are used to support our recruitment activities and are subject to human oversight and review. BrightSpring does not use AI to make employment decisions independently, and AI is not used to discriminate against applicants or employees. We do not use zip codes as a proxy for protected characteristics. All hiring decisions are made by people, including our recruiters and hiring leaders.
BrightSpring Health Services provides reasonable accommodations to qualified applicants and employees with disabilities. If you need a reasonable accommodation during the application or hiring process, please contact your recruiter or email TalentAcquisition@brightspringhealth.com. For additional information about how our company uses AI in the hiring process, please contact TalentAcquisition@brightspringhealth.com.
BrightSpring is an Equal Opportunity Employer.
BrightSpring Health Services and its affiliated companies provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
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