The Quality Assurance Auditor – SUD is responsible for planning and conducting regulatory and contractual compliance audits of providers delivering substance use and related disorder services across the State of Texas. This role verifies adherence to Health and Human Services (HHS/HHSC) requirements, contractual Statements of Work (SOWs), applicable Texas Administrative Code (TAC) provisions, and internal policies. The auditor drives quality improvement by tracking performance metrics, completing comprehensive reports, presenting findings, and partnering with providers on corrective action and sustainability.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Travel is required for this position.

• Regulatory Acumen: Interprets and operationalizes HHSC requirements, SOWs, and TAC standards.

• Audit Rigor: Applies structured methodologies, risk‑based sampling, and objective scoring.

• Data‑Driven: Converts metrics into insights; monitors CAP effectiveness.

• Communication & Influence: Writes crisp reports; presents to diverse audiences; builds provider buy‑in.

• Field Readiness: Manages extensive travel; adapts to varied provider settings statewide.

• Integrity & Judgment: Handles sensitive information; exercises impartial, evidence‑based decision‑making.

• Continuous Improvement: Identifies system gaps; recommends pragmatic, sustainable fixes.

Education and Experience:

Highschool Diploma/GED plus 6 years of experience in lieu of Bachelor’s degree requirement OR Bachelors Degree and 2 years of experience.

Bachelor’s degree in Healthcare Administration, Social Work, Public Health, Nursing, Behavioral Health, or related field is preferred

Two (2) years’ experience in healthcare quality, compliance/audit, utilization review, case management, or related function; SUD program experience strongly preferred.

Job Duties:

• Traveling: 30–50% statewide travel across Texas, including driving and flying to provider locations. Travel may include overnight stays and after‑hours work based on audit scheduling needs.

• Plan, schedule, and conduct full‑scope and targeted audits of SUD and related programs to verify compliance with HHSC regulations, contractual SOWs, and TAC requirements.

• Validate service delivery against contractually required service levels, client/participant satisfaction, service capacity, access to services, populations served, evidence‑based practices, and timeframes.

• Conduct on‑site visits across Texas to observe operations, perform data integrity checks across EHR/EMR systems, conduct facility walkthroughs, and evaluate environment of care.

• Produce clear, timely audit reports detailing scope, findings, ratings, and risk prioritization.

• Issue deficiency notices; collaborate with providers to develop Performance Improvement Plans (PIPs).

• Verify PIP implementation and effectiveness through evidence reviews.

• Present findings to providers, leadership, and network provider partners.

• Partner with provider network to align on standards and remediation.\

Physical Efforts:

• Sedentary (up to 10 pounds)

• Light (up to 20 pounds); ability to carry a laptop and audit materials

• Talking, standing, walking, repetitive hand motion, typing, hearing, sitting

• Prolonged periods of driving and/or flying for on-site visits

Working Environment:

• Office and frequent onsite facility environments (clinical, residential, outpatient)