[Hiring] Director of Clinical Quality and Compliance @Apollo Behavior

Role Description

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.

Qualifications

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

Requirements

• Stay ahead of payer changes and review updates to various payer manuals
• Review and approve all treatment plans (around 100 per month) before submission to payors
• Provide specific feedback to treating BCBAs and Clinical Directors
• Track denials, identify trends, and recommend improvements
• Help clinicians understand payer requirements and best practices in ABA

Benefits

• Salary: $85,000 - $110,000 (base salary with bonus)
• Location: Remote

Competencies

• Executing: Effectively manage time, schedules, and responsibilities
• Customer Service: Manage difficult client situations and respond promptly to needs
• Problem Solving: Identify and resolve problems on time
• Organizational Support: Follow policies and procedures correctly
• Oral Communication: Speak clearly and persuasively
• Written Communication: Write clearly and informatively
• Dependability: Follow instructions and keep commitments
• Quantity: Meet productivity standards
• Professionalism: Treat others with respect and consideration
• Math: Work with mathematical concepts effectively
• Organization: Organize materials for team accessibility

Physical and Environment Requirements

• Required Physical Activities: sitting, standing, walking, reaching, pushing, pulling, grasping, lifting, sprinting, talking, seeing, hearing, repetitive motions
• 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
• Exposure to potential allergens, including certain foods, scents, and environmental factors