Director of Clinical Quality, Compliance

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

📋 Description

• Stay informed about changes from payers. Analyze and interpret updates to various payer manuals and convert them into clear guidance for our clinical team.

• Review and authorize all treatment plans. Act as the final clinical approver for treatment plans and reassessments (approximately 100 per month) prior to submission to payors for prior authorization.

• Mentor and elevate the team. Provide targeted feedback to treating BCBAs and Clinical Directors, aiding in their growth and development as clinicians in crafting high-quality and compliant treatment plans and associated documentation.

• Foster quality and compliance. Monitor denials, spot trends, and suggest training, templates, or workflows that minimize errors and enhance outcomes.

• Serve as a resource. Assist clinicians in grasping the reasoning behind payer requirements and best practices in ABA.

⛳️ Requirements

• Master’s Degree in Applied Behavior Analysis (or equivalent).

• Experience in prior authorization review with Georgia payors.

• BCBA certification and licensure in Georgia.

• Computer Skills: Intermediate to advanced knowledge of Microsoft Office, including Excel, PowerPoint, and Word. Familiarity with database systems is preferred. Proficient with CentralReach and able to use various workflow management software, as well as comfortable utilizing AI tools to enhance documentation review and efficiency.

• Willingness to complete and successfully pass necessary background checks.

🏝️ Benefits

• Competitive salary and comprehensive health benefits.

• Opportunities for professional development and continuing education.

• Supportive team environment with a focus on collaboration and growth.

• Flexible work arrangements and a healthy work-life balance.