Quality Manager, Behavioral Health

This is a fully remote position, open to applicants in District of Columbia, +2 more states.

📋 Description

• Design, implement, and oversee quality assurance and quality improvement initiatives for behavioral health services in therapy and psychiatry.

• Establish and uphold chart audit processes to assess clinical documentation, treatment planning, medical necessity, risk assessment, coding compliance, and adherence.

• Supervise the timeliness, completeness, and quality of documentation; recognize trends and facilitate enhancements in collaboration with clinical and operational leaders.

• Perform documentation reviews and offer constructive feedback to healthcare providers.

• Create and implement clinical documentation standards, templates, workflows, and auditing tools.

• Monitor and assess quality metrics, including clinical outcomes, PHQ-9 and GAD-7 measurement frequency, symptom alleviation, patient satisfaction, complaints, incidents, and provider performance.

• Develop quality scorecards, dashboards, auditing tools, reports, and processes for measuring outcomes.

• Analyze quality data and generate summaries that include findings, recommendations, and action plans.

• Facilitate readiness for payer, regulatory, accreditation, and internal audits.

• Identify risks, bridge process gaps, enhance quality controls, and assist with investigations and corrective actions.

• Examine complaints, grievances, incident reports, safety issues, adverse events, and clinical risk concerns.

• Collaborate on peer reviews, case evaluations, provider training, documentation feedback, and performance enhancement.

• Offer clinical quality direction concerning documentation, evidence-based practices, workflows, care coordination, and management of high-risk patients.

• Aid in provider onboarding, training, coaching, and continuous education.

• Promote standardized workflows for referrals, scheduling, documentation, treatment planning, high-risk patient management, crisis escalation, care coordination, and follow-ups.

• Lead or engage in quality committees, workgroups, audits, performance improvement initiatives, and change management efforts.

• Utilize structured problem-solving techniques to identify root causes and support sustainable enhancements.

• Work collaboratively with behavioral health operations, clinical leadership, compliance teams, revenue cycle management, data analytics, product teams, customer service, credentialing, and other departments.

• Support the development of behavioral health policies, procedures, workflows, scorecards, outcome measures, and performance monitoring practices.

• May supervise Quality Assurance personnel or designated team members, providing leadership, training, mentorship, and accountability.

⛳️ Requirements

• Bachelor’s degree in healthcare administration, public health, behavioral health, social work, counseling, nursing, psychology, or a related discipline.

• 5–8 years of pertinent experience in healthcare quality management, operations in behavioral health, clinical quality assurance, compliance, or similar healthcare environments.

• Familiarity with behavioral health documentation standards, chart audits, treatment plans, medical necessity, risk assessments, and payer audit standards.

• Understanding of quality assurance and quality improvement principles, methodologies, and tools.

• Experience in gathering, reviewing, analyzing, and interpreting clinical, operational, and quality data.

• Strong knowledge of telehealth, outpatient behavioral health service delivery, and integrated or collaborative care models.

• Capability to develop workflows, auditing tools, policies, procedures, reports, scorecards, and improvement strategies.

• Excellent organizational skills with the capacity to manage multiple priorities, deadlines, and cross-functional projects.

• Outstanding written and verbal communication skills, including the ability to provide clear documentation feedback and present findings to leadership.

• Ability to work synergistically with clinical providers, operational leaders, compliance teams, revenue cycle management, product teams, data, credentialing, and customer service groups.

• Proficiency in Microsoft Office applications and comfort with electronic health records and reporting tools.

• Preferred: Active clinical license in VA, DC, or MD — LCSW-C, LICSW, LPC, LCPC, or LMFT.

• Preferred: Experience providing behavioral health services through telehealth platforms.

• Preferred: Familiarity with Athena or similar electronic health record systems.

• Preferred: Experience in supporting payer audits, regulatory evaluations, complaint and grievance processes, incident reviews, or corrective action plans.

• Preferred: Knowledge of PHQ-9, GAD-7, outcome measurements, provider performance metrics, and clinical quality dashboards.

• Preferred: Background in delivering clinical consultation, provider support, mentoring, supervision, or quality leadership within behavioral health settings.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and career growth.

• Supportive work environment that values collaboration and teamwork.