Clinical Quality Specialist (PT)

📋 Description

• Utilization Management & Review: conduct prospective, concurrent, and retrospective utilization
• Apply evidence-based UM criteria to evaluate clinical documentation and support authorization and
• Monitor care intensity and utilization trends to identify outliers and inform targeted provider
• Partner with health plans on external UR requests and peer-to-peer review coordination
• Clinical Quality & Provider Support: investigate and remediate provider concerns stemming from
• Monitor clinical adverse events and apply early-stage risk mitigation in partnership with

🎯 Requirements

• 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, medical necessity review, or clinical
• Familiarity with payor requirements, medical necessity criteria, and level-of-care guidelines
• Strong clinical judgment and experience handling escalations, adverse events, or quality-related
• Demonstrated ability to produce clear, accurate, and defensible clinical documentation

🎁 Benefits

• Compensation: hourly rate $40-$42 per hour for up to 30 hours/week (part-time)
• Flexible schedule during normal business hours in your time zone
• Equal opportunity employer