Clinical Quality Specialist

Job not on LinkedIn

🔥 0 minutes ago

🌵 Arizona, California, +9 more states – Remote

🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🎰 Nevada – Remote 🌲 North Carolina – Remote 🌲 Oregon – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ☕ Washington – Remote

💵 $90k - $120k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Vynca

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2014

💼 Consulting

⚕️ Healthcare Insurance

🏥 Healthcare

Consulting • Healthcare Insurance • Healthcare

Vynca is dedicated to helping patients with serious illnesses, such as cancer and heart failure, by providing expert palliative care services. Their comprehensive approach includes clinical care, social support, mental health counseling, and advance care planning, ensuring that patients receive compassionate, coordinated assistance at home or remotely. Vynca's mission is to enhance the quality of life for patients by managing symptoms, providing emotional support, and facilitating open discussions about healthcare goals and preferences.

📋 Description

• Conduct internal chart audits of Lead Care Managers across contracted health plans • Apply health plan audit criteria and Vynca internal quality standards • Maintain audit cadence and select samples according to chart composition requirements • Document findings with supporting evidence and analyze trends, risks, and opportunities • Participate in inter-rater calibration exercises • Support health plan and regulatory audit readiness, self-audit submissions, and corrective action plan responses • Maintain master audit records and monthly and quarterly quality reporting • Provide secondary clinical review of assessments, care management plans, and transitional care documentation • Provide clinical oversight, coverage, escalation support, and clinical guidance for complex member scenarios • Support interdisciplinary and multidisciplinary care team activity • Review clinical content in training materials, assessments, and job aids • Escalate clinical risk, member safety concerns, and quality-of-care issues • Partner with ECM Operations to translate audit findings into workflow changes and remediation • Collaborate on performance improvement plans and communicate results and at-risk staff to managers and directors • Partner with Training and Development on curriculum updates, education huddles, and remediation training • Support Compliance with audit readiness, regulatory monitoring, and QAPI activities • Deliver onboarding, ongoing, audit-related, and post-remediation training as needed • Develop criteria walkthroughs, documentation standards, findings reviews, knowledge checks, and competency tools • Support preceptor and shadowing activities as a clinical subject matter resource • Maintain audit-ready quality documentation • Monitor CalAIM, DHCS, and health plan criteria changes • Build and maintain plan-specific audit tools • Support ad-hoc quality initiatives, policy development, and special projects

🎯 Requirements

• Bachelor’s degree required • Active, unrestricted California clinical licensure required (RN, LCSW, LMFT, LPCC, or equivalent), or 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 QAPI activities • Experience with documentation integrity, including reviewing clinical documentation for accuracy, completeness, timeliness, and defensibility under audit • Willing and able to work Monday through Friday, 8:30am to 5pm Pacific Time • Working knowledge of clinical documentation standards, care plan development, and transitional care requirements • Strong analytical skills and ability to translate findings into actionable recommendations • Exceptional written communication skills 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 such as Zoom and Microsoft Teams • Ability to manage multiple priorities and competing deadlines • Cultural competence and ability to interact effectively with diverse populations • Experience with Medi-Cal populations, ECM, or CalAIM programs highly desirable • Bilingual proficiency in English and Spanish preferred • Familiarity with CalAIM, Enhanced Care Management, and community-based care models preferred • Experience with health plan delegation audits and corrective action plans preferred • CPHQ or CHC certification preferred • Experience with training delivery, curriculum development, or adult learning principles preferred • Experience with trauma-informed care or motivational interviewing preferred • Advanced spreadsheet skills preferred • Must complete background screening before employment • Employees in patient, client, or customer-facing roles must be vaccinated against influenza, subject to accommodations • Must satisfy U.S. employment eligibility verification through E-Verify

🏖️ Benefits

• Medical, dental, and vision insurance • Income protection benefits • Flexible PTO • Company holidays • 401k • Wellness benefits • Mileage reimbursement for field roles per IRS guidelines