Clinical Quality Specialist (PT)

About the Role

The part-time Clinical Quality Specialist role exists to safeguard and strengthen the clinical integrity of care delivered across the organization, with a focused lens on utilization management, payor-facing clinical audits, and clinical quality assurance. This position ensures that care is medically necessary, appropriately documented, and aligned with evidence-based standards and payor requirements supporting both provider success and defensible, compliant clinical operations.

Note: This is a part-time role up to 30 hours per week. The schedule is flexible, during normal business hours in your time-zone, during the week.

Responsibilities

• Conduct prospective, concurrent, and retrospective utilization reviews to assess medical necessity, treatment appropriateness, and level of care
• Apply evidence-based UM criteria to evaluate clinical documentation and support authorization and appeal processes
• Monitor care intensity and utilization trends to identify outliers and inform targeted provider interventions
• Partner with health plans on external UR requests and peer-to-peer review coordination
• Investigate and remediate provider concerns stemming from UM findings, client complaints, or external reports
• Monitor clinical adverse events and apply early-stage risk mitigation in partnership with cross-functional teams
• Support measurement-based care initiatives and identify opportunities to strengthen clinical outcomes across the provider network
• Track utilization metrics, review volumes, and case outcomes to inform quality improvement efforts
• Surface trends and process gaps to leadership and contribute to the ongoing refinement of UM policies and workflows

Requirements

• Master’s degree in a mental health discipline
• Active, cleared clinical license (e.g., LMFT, LPC, LCSW, LMHC, or equivalent) in good standing
• Experience in utilization management, utilization review, medical necessity review, or clinical auditing — ideally in a behavioral health or payor/health plan context
• Familiarity with payor requirements, medical necessity criteria, and level-of-care guidelines
• Strong clinical judgment and experience handling escalations, adverse events, or quality-related investigations
• Demonstrated ability to produce clear, accurate, and defensible clinical documentation
• Demonstrated ability to collaborate effectively across multiple teams
• Commitment to provider support and quality management
• Familiarity with clinical technology platforms for documentation, case tracking, and data analysis to support provider quality and compliance

Pay

The hourly rate for this part-time opportunity is $40-$42 per hour, up to 30 hours per week.

Schedule

The schedule is flexible, during normal business hours in your time-zone, during the week.