Director of Clinical Quality - Care Operations
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Equip HealthHealthcare
Remote - USAFull-TimeDirector
Salary140000 - 175000 USD per year
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Job Details
- Experience
- 8+ years
Requirements
- Master’s degree or higher in a behavioral health or clinical field (e.g., MD/DO, MSW, MFT/LMFT, LPC/LP, PsyD, PhD, APRN, NP, RN with clinical leadership focus, or equivalent)
- Independent clinical licensure applicable to your setting (e.g., MD/DO, LCSW, LMFT, LP, LPC, RN, APRN)
- 8+ years of experience in behavioral health with demonstrated expertise in either clinical quality improvement, utilization management, or a meaningful combination of both within virtual/telehealth, managed care, integrated delivery, or provider-based settings
- Demonstrated experience reviewing behavioral health clinical documentation and applying medical necessity criteria consistent with payer and regulatory requirements in a telehealth context
- Demonstrated knowledge of evidence-based standards relevant to behavioral health; familiarity with telemedicine adaptations of these standards and familiarity with eating-disorder treatment is a plus
- Direct experience designing or leading clinical quality programs in a virtual environment (e.g., chart audits, peer review, incident management, root cause analysis, policy/guideline development)
- 3+ years of progressive leadership experience, including people management of multidisciplinary teams (therapists, dietitians, physicians/apps, QM, UM, auditing, or compliance staff) in a remote or telehealth setting
- Proven ability to balance patient, provider, and payor interests while upholding clinical and ethical standards in a virtual care model
- Familiarity with governance structures (e.g., Clinical Quality Committee) and remote collaboration tools
- Proficiency with telehealth platforms, EMR/eClinical systems, and digital chart review; ability to leverage data to drive quality improvement in a virtual environment
- Familiarity with HIPAA privacy requirements and safeguarding confidential information in telehealth and cloud-based settings
- Knowledge of payer policies for virtual behavioral health, telemedicine reimbursement considerations, and utilization management workflows within remote care
- Understanding of regulatory and accreditation requirements impacting telebehavioral health
Responsibilities
- Design and oversee patient safety initiatives, safety reporting programs, and continuous clinical care improvement initiatives
- Provide oversight of clinical care standards across all disciplines ensuring alignment with evidence-based eating disorder treatment standards
- Develop and maintain clinical practice guidelines and documentation standards in partnership with discipline-specific leaders and the Compliance team
- Lead clinical incident investigations and root cause analyses in collaboration with the Compliance team
- Draft and revise clinical policies and procedures as informed by incident investigations, audit findings, and regulatory requirements
- Identify and elevate ethical care considerations, provide decision-making support on complex cases
- Collaborate closely with Equip’s Data Insights & AI team to establish metrics and dashboards to track clinical quality metrics
- Serve as the standing operational lead of the CQC — preparing agendas, presenting quality data, and ensuring follow-through on committee decisions
- Design and continuously improve chart audit and peer review programs, analyze quality data
- Provide direct oversight of the Utilization Management (UM) team, guiding UM team strategy
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