Licensed Clinical Reviewer (Per Diem)
About The Position
Under the direction of the Associate Director, the Licensed Clinical Reviewer supports clinical documentation review and quality assurance for CalAIM programming within Community HealthWorks. This role focuses on reviewing documentation to ensure alignment with program requirements, billing standards, and organizational expectations. This is a per diem, non-exempt (hourly) position with no guaranteed hours. Work will be assigned based on program needs. This position does not provide direct client care or serve as a primary clinical supervisor. While the role does not include routine direct client care, there may be occasional opportunities to support program staff with clinical guidance or client interaction, as appropriate.
Requirements
- Active California license in one of the following: Licensed Clinical Social Worker (LCSW), or Registered Nurse (RN)
- Experience working with Medi-Cal populations, managed care, or community-based services
- Experience reviewing or documenting clinical or service-related activities
- Strong attention to detail and ability to review documentation thoroughly and accurately
- Ability to apply judgment in assessing documentation and identifying gaps
- Clear and effective communication skills
- Ability to work independently and manage assigned workload within established timelines
- Commitment to serving underserved populations with cultural humility and respect
- Successful completion of a criminal background check
- Compliance with immunization and safety requirements, including COVID-19 policies as applicable
Nice To Haves
- Experience with Enhanced Care Management (ECM) and/or Community Supports preferred
Responsibilities
- Review client charts and service documentation for completeness, accuracy, and alignment with program requirements.
- Review comprehensive assessments completed by Community Health Workers (CHWs) and associated care plans to ensure clinical safety and appropriateness in addressing all identified gaps and physical, behavioral, and social determinants of health needs.
- Meet with CHWs to provide guidance and support in their development of person-centered care plans with individualized SMART goals.
- Determine client acuity based on assessment findings.
- Participate in Multidisciplinary Team meetings to case conference with CHWs and members of clients’ care teams.
- Assess and review documentation to support billing readiness, compliance with Medi-Cal, CalAIM and program standards and requirements and ensure and clinical appropriateness.
- Meet established turnaround times for assigned reviews (e.g., within 48–72 hours).
- Identify and flag documentation gaps, inconsistencies, or potential compliance risks.
- Support documentation quality and consistency to strengthen audit readiness and compliance.
- Support readiness for audits and internal quality review processes.
- Provide clear, actionable feedback to staff to strengthen documentation quality.
- Support consistency in documentation practices across programs.
- Maintain timely turnaround on assigned reviews.
- Document review outcomes in designated systems (e.g., Salesforce/NPC).
- Communicate findings and escalate concerns as appropriate.
- Perform other related duties as assigned.
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What This Job Offers
Job Type
Part-time
Career Level
Mid Level
Education Level
No Education Listed
