Director of Clinical Quality and Compliance

Director of Clinical Quality and Compliance

Job Summary

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.

Salary: $85,000 - $110,000 (base salary with bonus).

Location: Remote

Duties/Responsibilities

Compliance and Quality Assurance

• Stay ahead of payer changes. Review and interpret updates to various payer manuals and translate them into clear guidance for our clinical team
• 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  
• 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. 
• Drive quality and compliance. Track denials, identify trends, and recommend training, templates or workflows that reduce errors and improve outcomes. 
• Be a resource. Help clinicians understand the "why" behind payer requirements and best practices in ABA. 

Competencies

• Executing: Must effectively manage one's time, schedules, and responsibilities to ensure objectives are completed effectively and quickly.
• 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. 
• 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. 
• Organizational Support: Follows policies and procedures; completes administrative tasks correctly and on time; supports organizational goals and values; benefits the organization through outside activities.
• Oral Communication: Speaks clearly and persuasively in positive or negative situations; listens to get clarification; responds well to questions; demonstrates group presentation skills, participates in meetings. 
• Written Communication: Writes clearly and informatively; edits work for spelling and grammar, varies writing style to meet needs; presents numerical data effectively, and can read and interpret written clinical information. 
• Dependability: Follows instructions; responds to management direction; takes responsibility for own actions; keeps commitments; is consistently at work and on time, commits to long hours of work when necessary to reach goals; arrives at meetings and appointments on time; completes tasks on time or notifies appropriate person with an alternate plan.
• Quantity: Meets productivity standards; completes work in a timely manner; strives to increase productivity; works quickly. 
• Professionalism: Tactfully approaches others; reacts well under pressure; treats others with respect and consideration regardless of their status or position; follows through on commitments.
• Math: Ability to work with mathematical concepts such as probability and statistical inference, and to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. 
• Organization: Must be able to organize yourself and materials in a manner that all members of the clinical and operations team can locate and understand. High levels of detail-orientation are required.  

Job Requirements

Education and Experience

• Master's Degree in Applied Behavior Analysis (or equivalent)
• Experience working in prior authorization review with Georgia payors
• BCBA certification and licensed in Georgia 
• Computer Skills: Intermediate to advanced Microsoft Office, including Excel, PowerPoint, and Word. Skill with database systems preferred. Proficiency with CentralReach and the ability to use various workflow management software and comfortability with the use of AI tools to support documentation review and efficiency. 
• Willingness to complete and pass required background checks

Physical and Environment Requirements

• Required Physical Activities: sitting, standing, walking, reaching, pushing, pulling, grasping, lifting, sprinting, talking, seeing, hearing, repetitive motions. Quickly transition from seated or floor positions to standing, including rapidly getting up from the ground when needed, to ensure client safety and engagement.. 
• Characteristics of Work: frequent standing and walking, occasional sitting, lifting, and carrying objects up to 100 pounds.
• Vision Requirements: Close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
• This position may involve exposure to potential allergens, including certain foods, scents, cleaning products, and environmental factors (e.g., dust, pollen, pet dander). Individuals with known airborne, contact, or ingestion-related allergies must be able to safely perform essential job functions in these environments or provide documentation to support reasonable accommodation requests.