Catalight · 10 hours ago
Clinical Quality Reviewer
United States
Full-time
Remote
Senior Level
$85K/yr - $100K/yr
5+ years expCatalight is dedicated to improving the quality of services provided to clients, and they are seeking a Clinical Quality Reviewer to ensure compliance with healthcare standards. This role involves conducting quality reviews, collaborating with clinical staff, and developing quality improvement plans to enhance service delivery.
Health Care
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
Qualification
Required
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
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
Ability to obtain clearance through the Office of Inspector General
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
Ability to obtain and maintain criminal record clearance through the Department of Justice
Ability to obtain and maintain clearance through the Office of Inspector General
Company
Catalight
Catalight breaks down barriers and biases to create a more equitable world so people with developmental disabilities can choose their path.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Rodrigo Mahs
Executive Vice President, Growth and Innovation
Recent News
Behavioral Health Business
2025-12-29
Behavioral Health Business
2025-06-25
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