Quality Assurance Clinical Review Specialist (Pasadena)

Hillsides; Pasadena (TX); On-site; USD 3,857,280 - 4,270,560; Full time

Benefits offered by this job

Paid holidays

Vacation days

401(k) matching

Medical insurance

Dental insurance

Vision insurance

Life insurance

Long-term disability

PSLF eligible

Job summary

Hillsides in Pasadena seeks a Quality Assurance Clinical Review Specialist to oversee contract compliance and support clinical documentation. You will train staff, perform chart reviews, and ensure alignment with DMH, DCFS, and Medi-Cal standards.

The role requires a Master's in social work or related field and at least four years of EPSDT documentation experience. We offer a comprehensive benefits package, PSLF eligibility, and opportunities for professional growth in a mission-driven setting.

Qualifications

• Master's degree in social work or related field and licensure preferred.
• Four years' EPSDT-related documentation experience and Medi-Cal knowledge.
• Familiar with DMH, DCFS, MCP regulations and ethical standards.
• Ability to maintain a non-judgmental stance when working with youth and families.

Responsibilities

• Oversee contract compliance and coordinate with program managers and staff.
• Train staff and conduct chart reviews, audits and documentation reviews.
• Assist with regulatory compliance including Title 22 and COA requirements.
• Review fidelity of clinical models and manage corrective action plans.
• Prepare detailed reports and meeting minutes as needed.

Skills

EPSDT documentation

Compliance knowledge

Ethical standards

Non-judgmental attitude

Education

Master's degree in social work or related field

Job description

Quality Assurance Clinical Review Specialist (Pasadena)

Who We Are:

We are a premier provider dedicated to healing children and young adults, strengthening families, and transforming communities through quality, comprehensive services and advocacy. We envision a world in which children and young adults, families, and communities are able to heal, grow, and thrive.

Starting Salary Range: $28.00 - $31.00 per hour (based on experience)

What We Offer:

An outstanding benefits package and numerous opportunities for career growth and advancement within our organization!

• 13 Paid Holidays per year including Juneteenth
• Earn up to 16 days of paid vacation time, plus 50 hours of paid sick leave annually.
• 401(k) with no wait period and no vesting schedule
• 401(k) matching up to 4%
• Medical insurance offering 3 HMO with Kaiser and Health Net, and also a PPO Plan
• The Difference Card- Employer-funded benefit that works alongside an employee's health insurance plan to help offset out-of-pocket costs like copays, deductibles, and coinsurance.
• Dental insurance both HMO & PPO options, with 100% employer paid for HMO employee only coverage plan
• Vision insurance offers 100% employer-paid vision plan through EyeMed for you and your entire family
• Life and AD&D insurance 100% employer paid up to two times the annual salary
• Long Term Disability
• Flexible Spending Account for Medical and Dependent Care
• Employee Assistance Program
• This role is eligible for Public Service Loan Forgiveness (PSLF)

ESSENTIAL FUNCTIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.

The essential functions include:

• Oversee contract compliance (i.e. attending meetings, communicating/coordinating with Hillsides program managers/directors, training new staff, progress note/document reviews and audits, etc.)
• Work in conjunction with directors from programs to ensure training/support to contracted Campus Based Services Psychiatrists regarding Department of Mental Health (DMH), Department of Children and Family Services (DCFS), Managed Care Plans (MCP) documentation compliance.
• Attend Campus Based leadership meetings and County meeting/trainings and provide updates and trainings related to quality assurance/contract compliance as necessary
• Responsible for tracking any contract changes regarding Campus Based programs such as Short Term Residential Therapeutic Program (STRTP), Commercial Insurance and Transitional Housing Placement Program (THPP)
• Attend County meetings and trainings regarding Campus Based programs
• Collaborate with Campus Based leadership in setting protocols and procedures related to quality assurance and compliance
• Conduct clinical chart reviews, communicate and follow up on findings, and develop staff and manager trainings where gaps are identified
• Assist with record requests review and processing
• Assist QA/Compliance Department in maintaining compliance with regulations regarding the governing bodies of Community Care Licensing (Title 22), Counsel on Accreditation (COA), Medi-Cal Certification, Licensure, and Accreditations
• Review and approve the fidelity of the clinical model of Hillsides governing bodies (assessments, client treatment plan, discharge summary, annual paperwork, diagnosis updates, etc.), and request/oversee Correction Action Plan (CAP) from clinical staff, including contracting psychiatrist, when fidelity is non-compliant
• Make independent decisions and report those findings regarding concerns with quality care
• Interface with outside agencies to maintain current procedures, involvement in and lead coordination of audits performed by regulatory agencies
• Maintain robust knowledge base on compliance related to clinical documentation standards and their corresponding contracts. This will require active participation in clinical trainings offered within the agency or externally
• Submit program authorizations into DMH portal
• Prepare and submit detailed reports as needed
• Prepare for meetings and record meeting minutes as needed
• Other duties as required

EDUCATION, EXPERIENCE & CERTIFICATES

• Master's degree from an accredited or state approved program degree in social work, psychology or related mental health/human services field, license preferred
• Four years' experience with EPSDT related documentation and Short Doyle Medi-Cal
• Knowledgeable of the prevailing governmental laws and regulations regarding the provision of mental health services, including confidentiality and limits thereof, the reporting of child abuse/neglect, and related regulations
• Knowledgeable of and acts in accordance with Ethical and Professional Standards established by appropriate professional organizations, whether or not the individual is a member of any such organization
• Able to maintain a non-judgmental attitude toward youth and families

TRAUMA INFORMED CARE (TIC)

Hillsides practices Trauma Informed Care (TIC) principles which recognizes the signs, symptoms, and widespread impact of trauma; Employees are asked to comprehensively integrate knowledge of Trauma Informed Care into policies, procedures, and practices with the goal to prevent re-traumatization which promotes healing of families, youth, individuals, and communities.

Hillsides is an Equal Opportunity Employer

We welcome applicants from all backgrounds and do not discriminate based on any legally protected characteristic, including race, color, religion, sex, gender identity or expression, sexual orientation, national origin, ancestry, disability, medical condition, age, veteran or military status, or marital status, in accordance with applicable federal, state, and local laws. We are committed to providing reasonable accommodation(s) for individuals with disabilities throughout the application and employment process.