Clinical Quality Specialist
for section headings like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We must not repeat job title as heading. We need to include sections only if posting has real specific content.
We have content: About the job description (mission, values). That could be "About the role". Then responsibilities: list of duties (What You'll Do). Then qualifications: "Your Experience And Qualifications". Also "Preferred Qualifications". Could combine as Requirements/Qualifications. Also "Additional Information" includes hiring process, background check, vaccination requirement, etc. That's boilerplate; we should remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions. The Additional Information includes hiring process, background check, vaccination requirement, employment eligibility, EEO, environmental conditions. Many of those are boilerplate; we should remove them unless they contain substantive info not boilerplate. The vaccination requirement: "Employees in patient, client, or customer-facing roles must be vaccinated against influenza." That's substantive? Might be considered a requirement. Could include under Requirements? But it's a condition. Might be considered part of qualifications? Probably we can include a short paragraph under Requirements or Additional Info? The instruction: remove EEO/equal-opportunity/scam-warning boilerplate. Vaccination requirement is not EEO; it's a job requirement. Could keep as a short p under Requirements or maybe under "Additional Information" but we should avoid creating a section unless real specific content. Could embed within Requirements.
Pay: we have compensation range: $90K - $120K. So we need a Pay section with that.
Schedule: we have "Willing and able to work Monday through Friday 8:30am to 5pm Pacific Time." That's schedule info. So Schedule section.
Benefits: not mentioned. So omit Benefits.
Skills: maybe we can extract skills from qualifications: strong analytical skills, exceptional written communication, ability to deliver difficult feedback, proficiency with Google Suite, EHR, virtual collaboration platforms, highly organized, cultural competence. Could be a Skills section.
But we must not invent or summarize away detail. We can list them as bullet points under Skills if they appear explicitly. They are present: "Strong analytical skills with the ability to identify patterns across data and translate findings into actionable recommendations." "Exceptional written communication skills, particularly for documenting audit findings objectively and defensibly." "Ability to deliver difficult feedback constructively while maintaining professional credibility with clinical staff." "Proficiency with Google Suite, electronic health records, and virtual collaboration platforms (e.g., Zoom, Microsoft Teams)." "Highly organized with the ability to manage multiple priorities and competing deadlines within a dynamic setting." "Cultural competence and the ability to interact effectively with diverse populations." Those are explicit. So we can put them under Skills.
Requirements: we have Bachelor’s degree required, Master’s preferred, Active unrestricted California clinical licensure required (or ability to obtain within 6 months), 5+ years experience in care management, case management, or direct clinical practice, 1+ years experience in quality auditing, chart review, utilization review, or QAPI, previous experience with documentation integrity, willing to work Mon-Fri 8:30-5 PT, experience with Medi-Cal populations, ECM, or CalAIM programs highly desirable, working knowledge of clinical documentation standards, care plan development, transitional care requirements. Those are requirements/qualifications. We'll put them under Requirements (or Qualifications). The instruction says use headings like Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We can have both Requirements and Qualifications? Might be redundant. Better to have Requirements for mandatory, Qualifications for preferred? But we can combine. The instruction: "Use for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." So we can include multiple of those as needed. We'll include About the role, Responsibilities, Requirements, Qualifications, Skills, Pay, Schedule.
We must not repeat job title as heading. The job title is "Clinical Quality Specialist for the Enhanced Care Management (ECM) program". Not used as heading.
We must preserve all substantive information; do not invent or summarize away detail. So we need to include all bullet points from responsibilities, qualifications, etc.
We need to format lists with - . For prose, use
.
We must remove boilerplate: EEO, etc. Also remove duplicated lines. Also remove application instructions (like hiring process, background check, etc.) unless they contain substantive info like vaccination requirement. The vaccination requirement is a condition; we could include under Requirements maybe as a bullet: "Must be vaccinated against influenza (patient-facing role)". But the text says: "Vaccination Requirement: Employees in patient, client, or customer-facing roles must be vaccinated against influenza. Requests for religious or medical accommodations will be considered but may not always be approved." That's a requirement. We'll include under Requirements.
Also "Employment Eligibility: Compliance with federal law requires identity and work eligibility verification using E-Verify upon hire." That's a standard legal requirement; could be considered boilerplate? Might be considered standard but it's a requirement. However it's generic; maybe we can drop as boilerplate? The instruction: remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate. This is legal but not EEO. It's about work eligibility verification. Might be considered legal boilerplate. Safer to drop.
Background check etc: also legal boilerplate; drop.
Hiring process: application instructions; drop.
Environmental Conditions and Physical Requirements: maybe not boilerplate but could be considered generic; but it's substantive about physical demands. Could include under Requirements? Might be okay to keep as a short p under Requirements? But it's quite generic; but it's not EEO. However it's still somewhat boilerplate. I'd consider dropping to keep focused.
We'll keep: About the role (mission/values), Responsibilities (What You'll Do), Requirements (mandatory), Qualifications (preferred), Skills (explicit skills), Pay, Schedule.
Now we need to extract content precisely.
About the role: The first paragraph: "Join the dynamic journey at Vynca, where we're passionate about transforming care for individuals with complex needs. We’re more than just a team; we're a close-knit community. Our shared commitment to caring for each other and those we serve is what sets us apart. Guided by our unwavering core values: Excellence, Compassion, Curiosity, and Integrity, we forge paths of success together. Join us in this transformative movement where you can contribute to making a profound difference every day. At Vynca, our mission is to provide comprehensive care for more quality days at home."
That's about the role/company. We'll put under About the role.
Responsibilities: Under "What You'll Do" with subsections: Internal Auditing and Monitoring, Secondary Clinical Review and Clinical Oversight, Cross-Functional Collaboration, Training and Education Support, General Duties. We need to preserve all bullet points. We'll create a
with - for each duty. Could group under headings? But we only allowed
for section headings, not subheadings. We could just list all duties as list items. However we need to preserve the structure? The instruction: Use - for any list of duties/requirements/benefits. So we can just make a flat list of all duties. That's okay.
Let's extract each duty bullet:
From Internal Auditing and Monitoring:
- Conduct internal chart audits of Lead Care Managers across contracted health plans, applying each plan’s own audit criteria alongside Vynca internal quality standards.
- Maintain audit cadence in accordance with the ECM Internal Audit Cadence Standard Operation Procedure, including elevated cadence for new hires and staff on performance improvement plans.
- Select audit samples according to defined chart composition requirements, including discharge and enrollment mix and minimum enrollment tenure.
- Document findings objectively with supporting evidence locations so internal audit records can be used to respond to health plan documentation requests.
- Analyze results at the criterion, category, Lead Care Manager, and health plan level to identify trends, areas of opportunity, and emerging risk.
- Participate in inter-rater calibration exercises to confirm scoring consistency across auditors.
- Support audit readiness for health plan and regulatory audits, including self-audit submissions and corrective action plan (CAP) responses.
- Maintain the master audit record and reporting surfaces used for monthly and quarterly quality review.
Secondary Clinical Review and Clinical Oversight:
- Provide secondary clinical review of comprehensive assessments, care management plans, and transitional care documentation for clinical appropriateness, completeness, and defensibility, in addition to the oversight provided by Clinical Managers.
- Provide clinical oversight as needed, including coverage and escalation support where Clinical Manager oversight is unavailable or additional clinical review is warranted.
- Serve as a clinical resource to Lead Care Managers on complex member scenarios, escalation pathways, and documentation of clinical decision-making.
- Support interdisciplinary and multidisciplinary care team activity, including documentation of clinical oversight requirements.
- Review clinical content within training materials, assessments, and job aids for accuracy and alignment with scope of practice.
- Escalate identified clinical risk, member safety concerns, or quality-of-care issues through appropriate channels.
Cross-Functional Collaboration:
- Partner with ECM Operations leadership to translate audit findings into workflow change, documentation standards, and targeted remediation.
- Collaborate with Clinical and Program Managers on performance improvement plans, including audit-based evidence, progress monitoring, and tier and titration decisions.
- Partner with Training and Development Specialists to convert identified gaps into curriculum updates, education huddle content, and remediation training.
- Support the Compliance department on ECM audit readiness, regulatory monitoring, and quality assurance and performance improvement (QAPI) activities.
- Communicate results, trends, and at-risk staff to Clinical and Program Managers and to Directors.
Training and Education Support:
- Flex into training delivery as program needs require, including onboarding, ongoing education, and post-remediation reinforcement for Lead Care Managers.
- Develop and deliver audit-related education, including criteria walkthroughs, documentation standards, and findings review sessions.
- Contribute to the design and maintenance of knowledge checks, test-out assessments, and competency validation tools.
- Support preceptor and shadowing activities as a clinical subject matter resource.
General Duties:
- Maintain organized, audit-ready documentation of all internal quality activities.
- Monitor CalAIM policy changes, Department of Health Care Services (DHCS) guidance, and health plan criteria updates, and assess their impact on audit tools and documentation standards.
- Support the build and maintenance of plan-specific audit tools as health plan contracts are added or criteria change.
- Support ad-hoc quality initiatives, policy development, and special projects as assigned.
Now Requirements (mandatory):
- Bachelor’s degree required.
- Active, unrestricted California clinical licensure required (RN, LCSW, LMFT, LPCC, or equivalent), or the ability to obtain California licensure within the first six months of employment.
- 5+ years of experience in care management, case management, or direct clinical practice.
- 1+ years of experience in quality auditing, chart review, utilization review, or quality assurance and performance improvement (QAPI) activities.
- Previous experience with documentation integrity, including review of clinical documentation for accuracy, completeness, timeliness, and defensibility under audit.
- Willing and able to work Monday through Friday 8:30am to 5pm Pacific Time.
- Employees in patient, client, or customer-facing roles must be vaccinated against influenza. (We could add note about accommodations but maybe not needed.)
- Experience working with Medi-Cal populations, ECM, or CalAIM programs is highly desirable. (This is desirable, not mandatory; maybe put under Qualifications.)
- Working knowledge of clinical documentation standards, care plan development, and transitional care requirements. (This could be skill/qualification.)
We need to separate mandatory vs preferred. The posting says "Bachelor’s degree required. Master’s in Nursing
- . For prose, use
. We must remove boilerplate: EEO, etc. Also remove duplicated lines. Also remove application instructions (like hiring process, background check, etc.) unless they contain substantive info like vaccination requirement. The vaccination requirement is a condition; we could include under Requirements maybe as a bullet: "Must be vaccinated against influenza (patient-facing role)". But the text says: "Vaccination Requirement: Employees in patient, client, or customer-facing roles must be vaccinated against influenza. Requests for religious or medical accommodations will be considered but may not always be approved." That's a requirement. We'll include under Requirements. Also "Employment Eligibility: Compliance with federal law requires identity and work eligibility verification using E-Verify upon hire." That's a standard legal requirement; could be considered boilerplate? Might be considered standard but it's a requirement. However it's generic; maybe we can drop as boilerplate? The instruction: remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate. This is legal but not EEO. It's about work eligibility verification. Might be considered legal boilerplate. Safer to drop. Background check etc: also legal boilerplate; drop. Hiring process: application instructions; drop. Environmental Conditions and Physical Requirements: maybe not boilerplate but could be considered generic; but it's substantive about physical demands. Could include under Requirements? Might be okay to keep as a short p under Requirements? But it's quite generic; but it's not EEO. However it's still somewhat boilerplate. I'd consider dropping to keep focused. We'll keep: About the role (mission/values), Responsibilities (What You'll Do), Requirements (mandatory), Qualifications (preferred), Skills (explicit skills), Pay, Schedule. Now we need to extract content precisely. About the role: The first paragraph: "Join the dynamic journey at Vynca, where we're passionate about transforming care for individuals with complex needs. We’re more than just a team; we're a close-knit community. Our shared commitment to caring for each other and those we serve is what sets us apart. Guided by our unwavering core values: Excellence, Compassion, Curiosity, and Integrity, we forge paths of success together. Join us in this transformative movement where you can contribute to making a profound difference every day. At Vynca, our mission is to provide comprehensive care for more quality days at home." That's about the role/company. We'll put under About the role. Responsibilities: Under "What You'll Do" with subsections: Internal Auditing and Monitoring, Secondary Clinical Review and Clinical Oversight, Cross-Functional Collaboration, Training and Education Support, General Duties. We need to preserve all bullet points. We'll create a
- with
- for each duty. Could group under headings? But we only allowed
for section headings, not subheadings. We could just list all duties as list items. However we need to preserve the structure? The instruction: Use
- for any list of duties/requirements/benefits. So we can just make a flat list of all duties. That's okay. Let's extract each duty bullet: From Internal Auditing and Monitoring: - Conduct internal chart audits of Lead Care Managers across contracted health plans, applying each plan’s own audit criteria alongside Vynca internal quality standards. - Maintain audit cadence in accordance with the ECM Internal Audit Cadence Standard Operation Procedure, including elevated cadence for new hires and staff on performance improvement plans. - Select audit samples according to defined chart composition requirements, including discharge and enrollment mix and minimum enrollment tenure. - Document findings objectively with supporting evidence locations so internal audit records can be used to respond to health plan documentation requests. - Analyze results at the criterion, category, Lead Care Manager, and health plan level to identify trends, areas of opportunity, and emerging risk. - Participate in inter-rater calibration exercises to confirm scoring consistency across auditors. - Support audit readiness for health plan and regulatory audits, including self-audit submissions and corrective action plan (CAP) responses. - Maintain the master audit record and reporting surfaces used for monthly and quarterly quality review. Secondary Clinical Review and Clinical Oversight: - Provide secondary clinical review of comprehensive assessments, care management plans, and transitional care documentation for clinical appropriateness, completeness, and defensibility, in addition to the oversight provided by Clinical Managers. - Provide clinical oversight as needed, including coverage and escalation support where Clinical Manager oversight is unavailable or additional clinical review is warranted. - Serve as a clinical resource to Lead Care Managers on complex member scenarios, escalation pathways, and documentation of clinical decision-making. - Support interdisciplinary and multidisciplinary care team activity, including documentation of clinical oversight requirements. - Review clinical content within training materials, assessments, and job aids for accuracy and alignment with scope of practice. - Escalate identified clinical risk, member safety concerns, or quality-of-care issues through appropriate channels. Cross-Functional Collaboration: - Partner with ECM Operations leadership to translate audit findings into workflow change, documentation standards, and targeted remediation. - Collaborate with Clinical and Program Managers on performance improvement plans, including audit-based evidence, progress monitoring, and tier and titration decisions. - Partner with Training and Development Specialists to convert identified gaps into curriculum updates, education huddle content, and remediation training. - Support the Compliance department on ECM audit readiness, regulatory monitoring, and quality assurance and performance improvement (QAPI) activities. - Communicate results, trends, and at-risk staff to Clinical and Program Managers and to Directors. Training and Education Support: - Flex into training delivery as program needs require, including onboarding, ongoing education, and post-remediation reinforcement for Lead Care Managers. - Develop and deliver audit-related education, including criteria walkthroughs, documentation standards, and findings review sessions. - Contribute to the design and maintenance of knowledge checks, test-out assessments, and competency validation tools. - Support preceptor and shadowing activities as a clinical subject matter resource. General Duties: - Maintain organized, audit-ready documentation of all internal quality activities. - Monitor CalAIM policy changes, Department of Health Care Services (DHCS) guidance, and health plan criteria updates, and assess their impact on audit tools and documentation standards. - Support the build and maintenance of plan-specific audit tools as health plan contracts are added or criteria change. - Support ad-hoc quality initiatives, policy development, and special projects as assigned. Now Requirements (mandatory): - Bachelor’s degree required. - Active, unrestricted California clinical licensure required (RN, LCSW, LMFT, LPCC, or equivalent), or the ability to obtain California licensure within the first six months of employment. - 5+ years of experience in care management, case management, or direct clinical practice. - 1+ years of experience in quality auditing, chart review, utilization review, or quality assurance and performance improvement (QAPI) activities. - Previous experience with documentation integrity, including review of clinical documentation for accuracy, completeness, timeliness, and defensibility under audit. - Willing and able to work Monday through Friday 8:30am to 5pm Pacific Time. - Employees in patient, client, or customer-facing roles must be vaccinated against influenza. (We could add note about accommodations but maybe not needed.) - Experience working with Medi-Cal populations, ECM, or CalAIM programs is highly desirable. (This is desirable, not mandatory; maybe put under Qualifications.) - Working knowledge of clinical documentation standards, care plan development, and transitional care requirements. (This could be skill/qualification.) We need to separate mandatory vs preferred. The posting says "Bachelor’s degree required. Master’s in Nursing
- for each duty. Could group under headings? But we only allowed