Senior Manager, Clinical Quality

About Abby Care

Making family care possible. At Abby Care, we are tackling one of the most important and unsolved challenges of our time: family caregiving.

Over 50 million Americans are family caregivers for loved ones without pay, tools, or support. Our mission is clear and ambitious: to train and employ family caregivers so they can get paid for the care they already provide at home.

Abby Care is building a tech-powered, family-first care platform to efficiently deliver care, improve health outcomes, and provide the best-in-class experience nationwide.

We are rapidly expanding our mission and looking for passionate team members to join. Abby Care has partnered with leading insurance plans, healthcare providers, and community organizations. We’re supported by top, mission-driven VCs to empower families throughout the country.

The Role:

We are looking for a visionary and execution-focused Senior Manager, Clinical Quality to architect, scale, and oversee our clinical quality assurance and compliance frameworks. Reporting directly to corporate clinical leadership, this individual will safeguard clinical excellence across our rapidly expanding footprint (currently servicing CO, PA, MA, IN, FL, and soon expanding into TN, GA, and NJ).

The ideal candidate is a high-EQ clinical leader who thrives in a fast-paced, startup environment. You will be responsible for translating complex multi-state Medicaid regulations into seamless, tech-enabled clinical workflows. You will ensure that our clinical teams are empowered to deliver high-quality, compliant care that keeps families safely at home.

About you:

Deeply action oriented, you excel in fast paced, dynamic environments. If you are excited about the opportunity to build something important and truly make an impact where it matters most, we’d love to hear from you.

Key Responsibilities:

• Quality Program Architecture & Scaling

  • Design, implement, and evaluate Abby Care’s multi-state Clinical Quality Improvement (CQI) and Quality Assurance (QA) programs.

  • Partner closely with state Directors of Nursing and Clinical Leads to standardize clinical practices across all active and upcoming markets.

  • Build a deeply rooted organizational culture that prioritizes patient safety, exceptional care, and caregiver compliance.

• Regulatory Compliance & Audit Readiness

  • Serve as the internal subject matter expert on state-specific Medicaid paid family caregiving regulations, Electronic Visit Verification (EVV), and Home Health Agency (HHA) scope of practice.

  • Maintain and guarantee perpetual audit-readiness for state Departments of Health (DOH), CMS, and commercial payer reviews.

  • Deliver targeted remediation training and policy updates to clinical leadership when compliance gaps or regional regulatory updates occur.

• Clinical Documentation & Utilization Review

  • Oversee corporate charting standards and multi-state clinical audit frameworks.

  • Establish performance benchmarks for electronic charting, ensuring clinical necessity is robustly documented to protect authorization utilization and minimize compliance risk.

  • Analyze complex clinical data and Key Performance Indicators (KPIs), including patient readmission rates, extended visit trends, and clinical incident reports, to drive meaningful interventions and workflow improvements.

• Incident Management & Mitigation

  • Oversee the formal escalation, investigation, and reporting of all critical incidents across operations.

  • Ensure thorough Root Cause Analyses (RCA) are completed for variances and promptly deploy sustainable Corrective Action Plans (CAPs).

The Requirements

• Bachelor of Science in Nursing (BSN) required; Master’s degree in Nursing (MSN), Healthcare Administration (MHA), or Public Health (MPH) preferred.

• Current, active, and unencumbered license as a Registered Nurse (RN). Multi-state/Compact licensure is highly preferred, or a willingness to rapidly obtain licensure in upcoming expansion states.

• Minimum of 5 years of licensed clinical nursing experience, with at least 2–3 years in home health care, community health, or managed care environments.

• Minimum of 2 years of dedicated, proven experience in clinical quality management, healthcare compliance, or utilization review.

• Deep knowledge of OASIS, Home Health Agency (HHA) regulations, and CMS/Medicaid audit processes is highly preferred.

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