Licensed Clinical Quality Specialist

Job Summary

To support clinical integrity and quality assurance, the part-time Licensed Clinical Quality Specialist will conduct utilization reviews, collaborate with providers, and track quality metrics while working remotely up to 30 hours per week.

Key responsibilities

• Conduct prospective, concurrent, and retrospective utilization reviews to assess medical necessity and treatment appropriateness
• Investigate provider concerns and monitor clinical adverse events in collaboration with cross-functional teams
• Track utilization metrics and contribute to quality improvement efforts by identifying trends and process gaps

Required qualifications

• Master's degree in a mental health discipline
• Active, cleared clinical license (e.g., LMFT, LPC, LCSW, LMHC, or equivalent) in good standing
• Experience in utilization management, utilization review, or clinical auditing, preferably in a behavioral health context
• Familiarity with payor requirements and medical necessity criteria
• Strong clinical judgment with experience in handling escalations and quality-related investigations