Clinical Quality Specialist
New
V
VyncaHealthcare / Enhanced Care Management
Remote - United States. At this time we are only considering applicants in the following states: California, Arizona, Colorado, Florida, Georgia, Illinois, Nevada, North Carolina, Oregon, Texas, Utah and Washington., Monday through Friday 8:30am to 5pm Pacific TimeFull-TimeMiddle
Salary90,000 - 120,000 USD per year
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Job Details
- Experience
- 5+ years of experience in care management, case management, or direct clinical practice. 1+ years of experience in quality auditing, chart review, utilization review, or quality assurance and performance improvement (QAPI) activities.
- Required Skills
- Data AnalysisComplianceQuality AssuranceGoogle WorkspaceEHR
Requirements
- Bachelor's degree required; Master's in Nursing, Social Work, Public Health, or Health Care Administration preferred.
- Active, unrestricted California clinical licensure (RN, LCSW, LMFT, LPCC, or equivalent) or ability to obtain within 6 months.
- 5+ years of experience in care management, case management, or direct clinical practice.
- 1+ years of experience in quality auditing, chart review, utilization review, or quality assurance and performance improvement (QAPI).
- Experience with clinical documentation integrity and defensibility under audit.
- Strong analytical skills with the ability to identify patterns and translate findings into recommendations.
- Exceptional written communication skills for objective documentation.
- Ability to provide constructive clinical feedback.
- Proficiency with Google Suite, electronic health records, and virtual collaboration tools like Zoom or Microsoft Teams.
- Ability to work Monday through Friday, 8:30am to 5pm Pacific Time.
Responsibilities
- Conduct internal chart audits of Lead Care Managers using plan-specific criteria and internal standards.
- Document audit findings objectively to support health plan documentation requests.
- Analyze audit data to identify trends, emerging risks, and areas for clinical improvement.
- Provide secondary clinical reviews for assessments, care management plans, and transitional care documentation.
- Serve as a clinical resource for complex member scenarios and clinical decision-making.
- Collaborate with operations and training teams to translate audit findings into workflow improvements and curriculum updates.
- Deliver training, onboarding, and audit-related education to staff.
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