Quality Review Specialist III

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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 assessing whether individuals with intellectual developmental disabilities receive customized support and services • Conduct scheduled reviews of IDD service providers' effectiveness in preserving individuals' health and safety • Assist management in identifying service-delivery improvements and provide technical assistance • Administer detailed evaluations of programs and service providers for effectiveness and adherence to standards • Ensure compliance with laws, regulations, and policies related to developmental disabilities • Determine improvement areas 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 using a respectful, person-centered approach • 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, or exploitation according to established protocols • Conduct respectful interviews with individuals receiving services and provider staff • Document review findings accurately 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) • Ability to evaluate IDD programs and service providers against established standards • 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 service recipients and provider staff • Ability to document review findings and generate reports • Ability to take action in cases of abuse, neglect, or exploitation by following established protocols

🏖️ Benefits

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