Clinical Quality Reviewer

Catalight

1d•$85,000 - $100,000

About The Position

The Clinical Quality Reviewer is a critical member of the Foundation Company’s Quality Department to ensure and continuously improve the services provided to clients. This position is responsible for performing on-going assessments of quality of services and systems and for complex quality reviews to determine if the standard of care is rendered and/or if business standards have been met. This position is also responsible for working closely with clinical staff and leadership to ensure that clinical and treatment programs are producing work that meets quality and industry standards.

Requirements

Master’s degree and a minimum of 5 years’ clinical experience in child and youth behavioral healthcare services
Licensure or Associate Status in Psychology, Marriage and Family Therapy, Counseling, School Psychology, Speech Therapy, Occupational Therapy, Social Work, or BCBA required.
Minimum of 2 years of experience in healthcare quality assurance or similar work experience.
Demonstrated proficiency in medical record analysis and chart review guidelines.
Demonstrated experience in chart audits and quality assurance and improvement processes.
Ability to demonstrate team processes and facilitate skills.
Ability to apply healthcare data analysis to improve processes.
Ability to provide good customer service skills.
Ability to medically review; chart audits, and quality improvement processes.
Ability to analyze information and use logic and process to address work-related issues and problems.
Ability to be careful and thorough about detail.
Ability to function under pressure and deadline oriented project demands as well as manage multiple initiatives.
Ability to multi-task and prioritize.
Ability to organize well.
Ability to perform oral presentations.
Ability to work independently to meet objectives.
Ability to exercise confidentiality and discretion pertaining to the work environment.
Working knowledge of HIPAA privacy and Security rules.
Ability to communicate effectively verbally and in writing.
Strong long-form narrative writing skills
Ability to consistently demonstrate good judgment and decision-making skills.
Expert with Microsoft Office Suite and experience with technology and databases.
Sensitivity to working with an ethnically, linguistically, culturally, and economically diverse populations.
Ability to obtain and maintain criminal record clearance through the Department of Justice.
The Wellbeing & Experience department must analyze DOJ/FBI live scan reports in accordance with applicable federal, State and local laws as well as fitness for position.
Ability to obtain clearance through the Office of Inspector General
Frequent speaking and listening (25-75%) to clients, staff, and others in the workplace.
Visual and auditory ability to work with staff and others in the workplace continuously.
Ability to utilize computer and cell phone (iPhone).
Frequent proofreading and checking documents for accuracy.
Ability to work as closely in alignment with Pacific Standard Time (PST) schedule as possible

Responsibilities

Review and coordinate resolution to complaints, grievances, appeals, incident reports, clinical reviews and investigations
Conduct Clinical Quality Reviews to ensure standards of care and quality standards are met
Collaborate with Clinical Excellence and Operations to develop quality standards
Serve as a consultant to Clinical Programs on escalated or complex cases
Responsible for drafting and recommending Clinical Quality Policies and Procedures for review and approval
Collaborate on improving identified quality issues.
Work with business owners to facilitate quality improvement plan development and implementation as needed for both internal and external customers.
Offer quality improvement suggestions on project protocols and processes; facilitates quality improvement plan.
Develop and maintain policies, procedures, plans, schedules, and job aids for quality processes and systems.
Act as an objective source of independent advice to ensure validity, legality and goal achievement
Identify loopholes and recommend risk aversion measures
Maintain open communication with management and audit teams
Engage in continuous knowledge development regarding industry regulations, best practices, tools, techniques and performance standards
Under general supervision, works with Kaiser Permanente, CCS Providers and Regional Center staff to resolve any regulatory related issues.
Identify, plan, develop and execute performance improvement projects with the Quality Department and Programs leadership to achieve targeted objectives.
Serve as a subject matter expert for clinical quality
Assist with project data analysis, reporting and feedback.