Clinical Quality Reviewer

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. 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. Minimum Education, Experience & Training Equivalent to: • 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. Qualifications (Skills & Abilities): • 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 Physical Requirements: • 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 Conditions of Employment: • 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 and maintain clearance through the Office of Inspector General. Time Type: Full time Compensation: $85,000.00 - $100,000.00 Annually The statements contained in this job description reflect general details as necessary to describe the principal functions of this job. It should not be considered an all-inclusive listing of work requirements. Individuals may perform other duties as assigned, including work in other functional areas as deemed fit for the organization. Catalight is an equal opportunity employer. Apply tot his job Apply To this Job