Clinical Quality – Regulatory Leader

This is a fully remote position, open to applicants in United States.

📋 Description

• Act as the clinical quality lead for a designated portfolio of regions on behalf of the Chief Medical Office.

• Oversee, triage, and investigate critical incidents.

• Coordinate multidisciplinary investigations involving practice operations, clinical operations, HR, legal, and compliance leaders.

• Connect investigation outcomes with credentialing, peer review, Medical Executive, practice operations, and clinical operations committees.

• Compile incident reports, patient safety events, quality concerns, and quality metrics to identify trends.

• Collaborate with area leaders to utilize data and trends to enhance regional quality of care.

• Design and execute corrective actions and training programs aimed at addressing identified risks and preventing adverse events.

• Monitor and assess corrective actions and quality improvement initiatives through measurement, outcome analysis, and follow-up.

• Communicate regional quality, safety, and regulatory findings to the Chief Medical Office, Practice Operations, and Clinical Operations.

• Assist in morbidity and mortality rounds.

• Propel enterprise initiatives related to patient safety, clinical quality, regulatory compliance, and accreditation.

• Ensure adherence to state and federal requirements, accreditation standards, and company policy through chart audits.

• Aid in preparation for surveys and state audits, including follow-through on corrective action plans.

• Conduct site visits as necessary for survey support.

• Review clinical documentation against payer expectations and medical necessity requirements.

• Support payer audit outcomes through chart audits and action plans.

• Travel up to 50% to assigned regions, with occasional travel to Chief Medical Office and enterprise leadership meetings.

⛳️ Requirements

• Master's degree in a behavioral health discipline, nursing, a related clinical field, or equivalent experience.

• Minimum of five years delivering or overseeing behavioral health services, with direct experience in clinical documentation standards and chart review.

• Active, unrestricted clinical license preferred but not mandatory.

• Experience in conducting or supporting investigations of adverse events, quality of care concerns, or grievances.

• Capability to interpret regulatory and accreditation requirements and convert them into practical guidance.

• Proficient in data analysis, including creating and interpreting trend reports.

• Exceptional written and verbal communication, as well as presentation skills.

• Ability to handle competing priorities across multiple regions in a dynamic, matrixed environment.

• Legally authorized to work in the United States.

• Joint Commission or state licensure survey experience is preferred.

• Familiarity with Lean or Six Sigma methodologies is preferred.

• CPHQ or a comparable quality credential or experience is preferred.

• Background in focused and ongoing professional practice evaluation, peer review support, or credentialing and privileging is preferred.

• Multi-state or multi-site behavioral health experience, including payer audits and medical necessity documentation review is preferred.

• Residency in one of the regions this position will support is preferred.

• Ability to sit, stand, bend, talk, hear, walk on-site, and lift or move objects up to 25 pounds.

• Specific vision abilities including close, distance, peripheral vision, depth perception, and the ability to adjust focus.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• AD&D insurance.

• Short- and long-term disability insurance.

• Life insurance.

• 401k retirement savings with employer match.

• Paid parental leave.

• Paid time off.

• Holiday pay.

• Employee Assistance Program.

• Competitive bonus plan.