QA/Improvement Specialist

The Village Family Services, Inc.

Los Angeles (CA)

Hybrid

USD 97,826,131 - 103,297,958

Full time

14 days+

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Benefits offered by this job

Health insurance

403(b)

403(b) matching

Employee assistance program

Flexible spending account

Paid time off

Parental leave

Vision insurance

Life insurance

Referral program

Job summary

The Village Family Services is seeking a Quality Compliance and Improvement Specialist to strengthen regulatory compliance, improve documentation quality, and support audits across behavioral health programs in Los Angeles. The role collaborates with the QA Director and provides training to staff while promoting best practices in documentation and regulatory adherence.

Hybrid work (minimum 50% in-office) and a focus on LA County DMH/Medi-Cal compliance define the position’s day-to-day

Qualifications

Master's Degree in a behavioral health field.
Active ASW, AMFT, APCC, or licensed (LCSW, LMFT or LPCC).
Minimum 2 years' experience with LA County DMH documentation and Medi-Cal billing.
Familiarity with Electronic Health Records (EHR).
QA, utilization review, or compliance experience.
Hybrid work schedule with minimum 50% in office; schedule determined by the Director of Quality Assurance.

Responsibilities

Conduct comprehensive department audits across agency programs to ensure compliance with federal, state, county, Medi-Cal and regulatory requirements.
Identify documentation deficiencies and billing discrepancies; ensure timely corrective actions.
Develop and maintain audit tracking systems and reporting mechanisms for clinical documentation and service outcomes.
Provide training and technical assistance to staff on documentation standards and payer requirements.
Collaborate with management to implement corrective action plans and QA strategies.

Skills

QA experience

Attention to detail

Regulatory knowledge

Education

Master's Degree in behavioral health

Tools

EHR

Job description

The Village is accredited by the International Commission on Accreditation of Rehabilitation Facilities (CARF) for its Adoptions, Foster Care, Mental Health, Wraparound, and Drop-In Center services. We deliver evidenced-based behavioral health services to children, youth and adults, and has long been at the forefront of culturally sensitive foster care and adoption services.

This is an exciting opportunity to become part of team in a growing organization. We offer competitive compensation packages, including benefits such as health insurance, retirement plans, and paid time off. If you are a motivated individual with a passion and a desire to drive positive change within an organization,

POPOSITION DESCRIPTION:

The Quality Compliance and Improvement Specialist is responsible for monitoring and strengthening compliance with regulatory requirements, contractual standards, (e.g., Medi-Cal/DCFS), clinical expectations, and internal policies. Through structured audits, data analysis, utilization review, and clinical documentation review, the role identifies trends, evaluates effectiveness, and supports continuous quality improvement. The position also provides training and technical assistance to staff to ensure accurate documentation and regulatory compliance.

Responsibilities may include developing documentation tools, maintaining program records, tracking data, preparing reports and outcome measures, and providing technical assistance to departmental programs. The role operates under the direction of the Quality Assurance Director.

REQUIREMENTS & QUALIFICATIONS:

Master's Degree in a behavioral health field required
Active ASW, AMFT, APCC, or licensed (LCSW, LMFT or LPCC)
Minimum 2 years' experience with LA County DMH documentation and Medi-Cal billing
Familiarity with Electronic Health Records (EHR)
A combination of training and experience exhibits the knowledge, skills, and abilities necessary to perform the essential duties of this position
QA, utilization review, or compliance experience
Hybrid work schedule. Minimum 50% in office; the work schedule will be determined by the Director of Quality Assurance.

DUTIES & RESPONSIBILITIES:

All of the responsibilities listed below are considered essential functions of this position. Additionally, this position is expected to ensure adherence to the core operating values and the strategic direction of the agency.

Clinical Documentation, Compliance & Audit Oversight

Conduct comprehensive department audits across agency programs including behavioral/mental health, child welfare, housing, and adjunct services. Responsibilities include, but are not limited to, utilization reviews, records review, audit readiness, data analysis, etc., to ensure compliance with Federal, State, and County, Medi-Cal, BHSA, HIPAA, and all applicable regulatory and contractual requirements.
Maintain current knowledge of clinical documentation standards, regulatory updates, and payer requirements; implement updates and ensure agency-wide adherence.
Identify documentation deficiencies, compliance risks, and billing discrepancies; ensure timely corrective actions and follow-up with clinicians and supervisors.Evaluate medical necessity, service appropriateness, and treatment effectiveness through clinical record review.
Maintain audit tracking systems and ensure proper documentation of review outcomes, corrective actions, and compliance status.

Quality Improvement, Utilization Review & Risk Management

Support and assist in the implementation of agency-wide quality improvement (QI), utilization review (UR), risk management, safety, and clinical records review processes.
Analyze audit findings and performance data to identify trends, systemic issues, and opportunities for improvement.
Collaborate with the Quality Assurance Director to develop and implement corrective action plans and quality improvement strategies.
Contribute to audit readiness efforts, including preparation for internal, external, county, and payer audits.
Recommend and support the development of policies, procedures, and workflows that strengthen compliance and documentation quality.

Reporting, Data Management & Outcomes Monitoring

Prepare and deliver weekly, monthly, and ad hoc reports on audit results, compliance trends, and quality indicators.
Develop and maintain data tracking systems, audit tools, and reporting mechanisms for clinical documentation, utilization review, and service outcomes.
Monitor program performance and support the tracking of service-specific outcome measures and compliance benchmarks.
Maintain accurate records of audits, training activities, and quality improvement initiatives

Training, Technical Assistance & Staff Development

Serve as a subject-matter expert in clinical documentation, compliance, and quality assurance.
Provide ongoing training and coaching to staff, supervisors, and interdisciplinary teams on: Documentation standards, County requirements, EHRS and AI documentation tools
Offer technical assistance and consultation to improve documentation quality, compliance, and audit performance.
Support staff development by reinforcing best practices and promoting continuous quality improvement across programs.

Collaboration & Cross-Functional Support

Collaborate with management teams to ensure alignment with compliance and documentation standards.
Coordinate with external stakeholders (e.g., DMH, DCFS, HSH) as needed to support compliance and quality initiatives.
Participate in agency-wide committees, meetings, and county/funder trainings to stay aligned with system changes and expectations.

Records Management, Operational Support & Field Work

Review and process clinical records requests in collaboration with the QA Director, ensuring compliance with confidentiality and legal requirements.
Travel to program sites as needed to conduct audits, provide training, and support program compliance efforts.
Assist in maintaining documentation tools, templates, and standardized processes to support clinical documentation quality.

Other Responsibilities

Uphold strict adherence to confidentiality, HIPAA, and all applicable state and federal regulations.
Attend regularly scheduled agency wide meetings, utilization review meetings, community meetings and other meetings as required or assigned
Comply with applicable professional licensing, registration, or certification requirements (if applicable) and ethics
Conduct all functions in accordance with Agency guidelines, policies and procedures
Arrange work schedule or required hours to the benefit of the program
Perform other duties and responsibilities that may be necessary or in the best interest of the agency as assigned by Supervisor
Hybrid work schedule minimum 50% in office - schedule to be determined by the Director of Quality Assurance

Physical Activity:

Prolonged Sitting/Standing: The role frequently requires sitting for extended periods while reviewing electronic health records (EHR) and working on a computer.
Computer Use: Extensive use of hands, arms, and fingers for typing, utilizing keyboards, mouse, and telephone headsets.
Mobility: Ability to move around an office, stand, and walk for brief periods.
Lifting: Demonstrating the ability to lift and carry materials, such as files, binders, or equipment, weighing up to 10-15 pounds.
Sensory Requirements: Clear vision for reading printed materials and computer screens, as well as functional hearing and speech for phone communication and meetings.

Confidentiality and Privacy

Adheres to all legal parameters for ensuring and maintaining clients' confidentiality, including HIPAA, State and Federal laws.

The Village Family Services provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Job Type: Full-time

Pay: $34.14 - $36.05per hour