Clinical Quality Analyst

Jobtailor; California (MO); Hybrid; USD 60,000 - 90,000; Full time

Job summary

Jobtailor is seeking a Quality and Compliance Auditor to ensure adherence to medical and clinical guidelines across programs. The role emphasizes audits, incident analysis, and collaboration with clinical teams to mitigate risk and improve documentation and processes.

The ideal candidate brings 2+ years in healthcare auditing, strong HIPAA and Joint Commission knowledge, and proficiency with MS Office. A hybrid work setup is expected for eligible applicants near select offices.

Qualifications

• 2+ years of experience in healthcare auditing.
• Bachelor’s or master’s degree in behavioral health or similar field preferred.
• Healthcare or behavioral health operations experience preferred.
• Strong knowledge of state and federal patient confidentiality laws.
• Knowledge of ASAM criteria.
• Knowledge of The Joint Commission Behavioral Health Standards.
• Comprehensive understanding of healthcare regulatory and compliance, including HIPAA.
• Proficient in Microsoft Office, especially Word & Excel.

Responsibilities

• Ensure quality medical and clinical processes comply with guidelines.
• Perform and manage quality assurance and clinical audits for quality, accuracy, and consistency.
• Collaborate with clinical teams to resolve findings and identify trends or broader areas of risk.
• Review incident reports and support serious incident analysis.
• Audit assigned medical and clinical records daily and meet productivity expectations.
• Provide education and feedback based on audit findings.
• Lead or participate in quality improvement processes and initiatives.
• Submit medical records within required timeframes.
• Report on compliance and quality initiatives.

Skills

Healthcare auditing

HIPAA regulations knowledge

Joint Commission standards knowledge

Confidentiality management

Independent functioning

Effective communication

Problem-solving

Collaboration

Education

Bachelor’s or Master’s degree in behavioral health or similar field

Tools

Microsoft Word

Microsoft Excel

Job description

• Ensure quality medical and clinical processes comply with company, industry, accreditation, state, and federal guidelines
• Perform and manage quality assurance and clinical audits for quality, accuracy, and consistency
• Collaborate with clinical teams to resolve findings and identify trends or broader areas of risk
• Review incident reports and support serious incident analysis
• Participate in survey preparation and readiness initiatives
• Assist with corrective action plans and new state or program launches
• Develop and evaluate workflow procedures to ensure documentation compliance
• Assist with system policies, procedures, knowledge base, process improvements, and system improvements
• Audit assigned medical and clinical records daily and meet productivity expectations
• Apply audit criteria consistently and accurately
• Complete monitoring reports summarizing audit results, findings, and trends
• Provide education and feedback based on audit findings
• Lead or participate in quality improvement processes and initiatives
• Support clinical teams implementing quality improvement initiatives
• Develop cross-company documentation procedures supporting clinical compliance
• Collaborate with administration and other departments on interdepartmental procedures
• Notify the Quality and Safety Manager about medical-record integrity matters
• Maintain confidentiality of audit reviews and findings
• Submit medical records within required timeframes
• Report on compliance and quality initiatives
• Provide reports to the Director of Quality, Safety, and Compliance Operations
• Participate in state, Medicaid, payer, and accreditation survey-preparedness initiatives
• Assist with incident reporting, review, tracking, and investigation
• Support corrective action plans and required follow-up
• Support Quality and Safety readiness for new state or program launches
• Participate in special projects and perform other assigned duties

Requirements

• 2+ years of experience in healthcare auditing
• Bachelor’s or master’s degree in behavioral health or similar field preferred
• Healthcare or behavioral health operations experience preferred
• Strong knowledge of state and federal statutes regarding patient confidentiality laws
• Knowledge of ASAM criteria
• Knowledge of mental health recovery model and LOC guidelines
• Knowledge of behavioral health guidelines or assessments, treatment plans, and LOC
• Knowledge of The Joint Commission Behavioral Health Standards
• Ability to work with sensitive and/or confidential information
• Proficient in Microsoft Office, especially Word & Excel
• Basic understanding of applicable laws, regulations, industry standards, and related compliance issues, particularly regarding The Joint Commission and State accreditation
• Comprehensive understanding of healthcare regulatory and compliance, including HIPAA
• Ability to function independently with minimal supervision
• Ability to collaborate effectively with clinical and cross-functional teams
• Applicants living within 45 minutes of a Charlie Health office must adhere to a hybrid work schedule
• Applicants in California, Colorado, New York, and Washington are not currently being considered

Core Competencies

Demonstrates expertise in healthcare auditing and compliance, with a strong understanding of state and federal regulations, including HIPAA and The Joint Commission standards. Capable of leading quality improvement initiatives and collaborating effectively with clinical teams to enhance documentation and operational processes.

Highest-signal resume keywords

• Healthcare Auditing Experience
• Knowledge of HIPAA Regulations
• Understanding of The Joint Commission Standards
• Proficient in Microsoft Office
• Behavioral Health Operations Experience

Hard Skills

• Healthcare Auditing
• Quality Assurance Audits
• Incident Reporting
• Corrective Action Plans
• Documentation Compliance
• Audit Criteria Application
• Monitoring Reports
• Workflow Procedure Development
• Clinical Compliance
• Behavioral Health Guidelines Knowledge

Soft Skills

• Collaboration
• Confidentiality Management
• Independent Functioning
• Effective Communication
• Problem-Solving

Industry Keywords

• Patient Confidentiality Laws
• ASAM Criteria
• Mental Health Recovery Model
• LOC Guidelines
• Behavioral Health Assessments
• Quality Improvement Processes
• State Accreditation
• Medicaid Compliance
• Clinical Teams Collaboration
• Survey Preparedness