Quality Review Specialist III

🔥 2 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $54.6k - $59k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Qlarant

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1973

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Qlarant is a US-based services and technology firm specializing in healthcare program integrity, offering quality improvement, fraud, waste & abuse (FWA) detection and investigative services, and advanced data analytics and predictive modeling tools (the RIViR® Risk Solution Suite) for government agencies, health plans, and related sectors. The company also operates initiatives like the Qlarant Foundation and Qlarant Capital to fund grants and early-stage startups, and provides pharmacy, drug pricing, and transportation-focused solutions.

📋 Description

• Facilitate routine evaluations of services for individuals with intellectual and developmental disabilities (IDD) • Conduct scheduled reviews of IDD service providers to assess health, safety, effectiveness, and adherence to standards • Administer detailed evaluations of programs and service providers • Ensure compliance with relevant laws, regulations, and policies • Identify areas for improvement and collaborate with stakeholders on quality enhancement initiatives • Inspect provider documentation, reports, and records • Advocate for the rights and well-being of individuals with developmental disabilities • Analyze program outcomes, client satisfaction, and other relevant metrics • Communicate with service providers, agencies, and stakeholders • Develop and provide technical assistance, training, and guidance on best practices, quality standards, and compliance • Take immediate action in cases of abuse, neglect, and/or exploitation according to established protocols • Conduct interviews with service recipients and provider staff • Document review findings and generate reports • Plan and arrange own work while working with the manager to prioritize projects

🎯 Requirements

• Minimum Bachelor's Degree required; education can be substituted for experience • 5–7 years of work experience required; 8–11 years preferred • Must meet the criteria to be a Developmental Disabilities Professional (DDP) • Must meet the criteria to be a Qualified Intellectual Disabilities Professional (QIDP) • Knowledge of laws, regulations, policies, quality standards, and compliance requirements related to developmental disabilities • Ability to analyze program outcomes, client satisfaction, and other relevant metrics • Ability to conduct respectful interviews with individuals receiving services and provider staff • Ability to exercise professional judgment and follow protocols in cases of abuse, neglect, and/or exploitation • Successful completion of pre-employment background and drug screens

🏖️ Benefits

• Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities • Drug-free workplace • Employment offers contingent upon successful completion of pre-employment background and drug screens

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