Clinical Quality Auditor, Consultant

Your Role

The Quality Review team completes audits of front-line staff to ensure alignment with department processes and regulatory compliance. Clinical Quality Auditors also provide coaching and work closely with business leaders to drive optimal results. The Clinical Quality Auditor, Consultant will report to the Quality Review Senior Manager. In this role you will develop performance metrics, evaluate performance, and provide coaching to ensure that staff have the skills and knowledge required to be successful in Behavioral Healthcare plan administration.

Your Knowledge and Experience

• A college degree or equivalent experience and minimum and 7 years of prior relevant experience required.
• Current unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) required.
• At least 5 years of experience in managed care or similar Behavioral Health healthcare environment preferred
• Auditing experience preferred
• Familiarity with Mental Health/Substance Use Disorder (MH/SUD) Non-Profit Criteria preferred (CALOCUS, LOCUS, ASAM)
• Knowledge of Behavioral Health Utilization Management including ability to apply and interpret admission and continued stay clinical against nonprofit association guidelines
• Familiarity with medical terminology, diagnostic terms, and treatment modalities including ability to comprehend psychiatric evaluations, clinical notes, and lab results
• Strong organizational and/or project management skills to coordinate departmental projects and to perform multiple projects or tasks simultaneously
• Subject matter expert with capability to effectively audit and train all lines of business (Commercial, Federal Employee Program, Medicare, and Medi-Cal)