<h3><strong>Director of Clinical Quality and Compliance</strong></h3><h3>J<strong>ob Summary</strong></h3><p><strong>The Director of Clinical Quality and Compliance serves as Apollo Behavior’s subject-matter expert on payer requirements — including Medicaid, TRICARE, and the Georgia Department of Community Health (DCH) — and acts as the final approver of treatment plans prior to submission for prior authorization. The position is responsible for reviewing approximately 100-130 treatment plans per month. Through detailed plan review, payer-manual monitoring, and structured feedback to clinical staff, this position ensures treatment plans are clinically sound, meet all medical necessity criteria, and aligned with the most current payer and regulatory standards.</strong></p><p><strong><strong>Salary</strong><strong>:</strong>$85,000 - $110,000 (base salary with bonus).</strong></p><p><strong><strong>Location:</strong>Remote</strong></p><h3><strong>Duties/Responsibilities</strong></h3><h3><strong>Compliance and Quality Assurance</strong></h3><ul><li><strong>Stay ahead of payer changes. Review and interpret updates to various payer manuals and translate them into clear guidance for our clinical team</strong></li><li><strong>Review and approve all treatment plans. Serve as the final clinical approver of treatment plans and reassessment (around 100 per month) before they are submitted to payors for prior authorization </strong></li><li><strong>Coach and elevate the team. Provide specific feedback to treating BCBAs and Clinical Directors that help them grow and develop as clinicals in their ability to create top tier and compliant treatment plans and other related documentation. </strong></li><li><strong>Drive quality and compliance. Track denials, identify trends, and recommend training, templates or workflows that reduce errors and improve outcomes. </strong></li><li><strong>Be a resource. Help clinicians understand the “why” behind payer requirements and best practices in ABA. </strong></li></ul><h3><strong>Competencies</strong></h3><ul><li><strong>Executing: Must effectively manage one’s time, schedules, and responsibilities to ensure objectives are completed effectively and quickly.</strong></li><li><strong>Customer Service: Manages difficult or emotional client situations; responds promptly to parent needs; solicits parent feedback to improve service; responds to requests for service and assistance; meets commitments. </strong></li><li><strong>Problem Solving: Identifies and resolves problems on time; gathers and analyzes information skillfully; works well in group problem-solving situations; uses reason even when dealing with emotional topics. </strong></li><li><strong>Organizational Support: Follows policies and procedures; completes administrative tasks correctly and on time; supports organizational goals and values; benefits the organization through outside activities.</strong></li><li><strong>Oral Communication: Speaks clearly and persuasivel