Source Job

$72,000–$82,000/yr
US 3w PTO

  • Provide ongoing support to providers to help them maintain high-quality care delivery and professional growth.
  • Monitor, track, and respond to clinical adverse events.
  • Work with Customer Support, Product, Provider Success, Clinical Quality, and Care Coordination teams to execute end-to-end clinical roadmaps and SOPs.

Quality Management Collaboration Mental Health SOP

20 jobs similar to Clinical Quality Specialist

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US

Serve as the go-to clinical expert for clinician questions and escalations. Support patient care, including escalated and DEA-required visits. Partner with the Medical Director on clinical quality, education, and safety.

Midi Health is the leading virtual clinic for women in midlife, transforming the way perimenopause and menopause are treated with expert, evidence-backed care.

$162,000–$258,700/yr
US

  • Define and own the product roadmap for the member-facing mobile app experience, focusing on key user journeys.
  • Spearhead the strategy and delivery of internal provider companion tools that integrate with the member experience to enable high-quality care.
  • Partner with Clinical Operations, Legal, and Compliance teams to integrate evidence-based practices and ensure digital experiences meet HIPAA/privacy compliance standards.

Headspace exists to provide every person access to lifelong mental health support and combines evidence-based content, clinical care, and innovative technology.

Unlimited PTO

Respond to customer questions and requests via email. Triage tickets and perform escalations to appropriate teams. Develop and maintain a deep understanding of our product offerings.

Prompt is revolutionizing healthcare by delivering highly automated and modern software to rehab therapy businesses, the teams within, and the patients they serve.

$50,000–$50,000/yr
US

  • Coordinate comprehensive onboarding for new therapists and nurse practitioners.
  • Serve as the main point of contact for provider questions, concerns, and technical issues.
  • Monitor provider satisfaction and engagement, identifying opportunities for improvement.

Seven Starling is revolutionizing women's behavioral health through our clinically-validated virtual care platform. As a venture-backed, rapidly scaling startup at the forefront of maternal healthcare innovation, they have developed a groundbreaking clinical model that combines specialized therapy, peer support, and medication management to effectively treat perinatal mood disorders.

  • Lead end-to-end planning, rollout, and evaluation of initiatives; oversee pilots and guide successful scale-up.
  • Align Coaching, Product, Analytics, and provider leaders on goals, deliverables, and timelines; surface risks and unblock issues quickly.
  • Identify opportunities to streamline workflows, enhance quality, and reduce provider/nurse effort; craft clear communications and training assets for smooth adoption.

Virta Health is on a mission to transform type 2 diabetes and weight-loss care by helping people reverse their metabolic condition.

$40,000–$55,000/yr
US Canada

  • Lead the full credentialing lifecycle for new and existing providers and practice locations including Medicare and Medicare Advantage plans.
  • Ensure CAQH profiles are complete, current, and accurately reflect provider credentials and practice information.
  • Assess current credentialing processes, identify inefficiencies, and implement improvements using Airtable, automation tools, and best practices.

Sailor Health is on a mission to solve the mental health crisis among older adults, building the platform for senior mental health.

US

  • Assists with medical record documentation requests and leverages medical management system to initiate case and/or authorization to support clinical processes.
  • Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes.
  • Actively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership.

Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote it one of the “Best Places to Work in PA”.

  • Be the primary point of contact for all providers.
  • Provide professional, accurate and timely responses to all provider inquiries.
  • Maintain a current knowledge of all contract requirements and objectives.

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans.

$49,920–$54,080/hr
US

  • Facilitate all aspects of required medical licensure for clinical personnel.
  • Drive the licensing process in a proactive, organized and streamlined manner.
  • Collaborate with credentialing, onboarding, and clinical teams.

Talkiatry is a national mental health practice co-founded by a patient and a triple-board-certified psychiatrist. They provide patients with the care they need and allow psychiatrists to focus on medicine with innovative technology and a human-centered philosophy.

US 4w PTO

The Quality Reporting Specialist plays a critical role ensuring practice and ACO success in Medicare Advantage and commercial contracts, with a focus on HEDIS quality measures. Apply knowledge of HEDIS quality measures for addressing incentivized, contract measures across multiple Medicare Advantage and commercial health plans. Submit documentation to health plans and employ the optimal methods in each practice.

Aledade exists to empower the most transformational part of our health care landscape - independent primary care.

$79,352–$79,352/hr
US

  • Manage client crises using evidence-based interventions, providing risk assessment and safety planning.
  • Identify roadblocks to clinical care and connect clients to the ideal treatment using Lyra’s proprietary software.
  • Independently manage a caseload of complex, multi-need clients.

Lyra Health is the leading provider of mental health solutions for employers, supporting more than 20 million people globally. They have delivered 13 million sessions of mental health care and are known for their AI-powered platform and focus on improving access to high-quality mental healthcare.

$54,995–$62,005/yr
US Unlimited PTO 13w maternity

  • Ensuring providers are credentialed in a timely manner by monitoring the submission process.
  • Monitoring submission processes, updating protocols, and managing Virtual Assistants/BPO.
  • Communicating with payors and conducting regular reviews to validate internal credentialing data.

Grow Therapy aims to be the trusted partner for therapists growing their practice, and patients accessing high-quality care. They are a three-sided marketplace that empowers providers, augments insurance payors, and serves patients and have empowered more than ten thousand therapists.

US

  • Answer incoming inquiries from patients, answer questions, and schedule appointments
  • Make outbound phone calls to patients, pharmacies, and insurance companies
  • Create and triage tickets in ServiceNow

Talkiatry transforms psychiatry with accessible, human, and responsible care. They’re a national mental health practice co-founded by a patient and a triple-board-certified psychiatrist to solve the problems both groups face in accessing and providing the highest quality treatment.

$68,000–$78,000/yr
US 5w PTO

  • Support the Client Success Manager with day-to-day tasks such as email correspondence and meeting notes.
  • Manage the client-facing inbox, responding to inquiries and escalating issues as needed.
  • Analyze client data and metrics to generate insights for internal decision-making and client initiatives.

Cohere Health’s clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration.

US

  • Provides data management support services to Dignity Health’s CI/ACO Networks, Employer Relations and Valued Based Operations (VBO).
  • Within the Salesforce platform, this individual gathers and maintains accurate provider data, performs periodic provider data reconciliations with multiple data sources.
  • Maintains and transmits fee schedules, as necessary, to third-party administrators (TPA's) and other appropriate stakeholders.

Dignity Health MSO builds a system-wide integrated physician-centric, full-service management service organization structure. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers.

US

  • Provide real-time operational support to physicians.
  • Manage schedules across 1099 and W2 providers.
  • Serve as a key liaison between providers and patients.

Solace is a healthcare advocacy marketplace connecting patients and families to experts who help them understand and take charge of their personal health. They're a Series B startup founded in 2022, backed by Inspired Capital, Craft Ventures, and Menlo Ventures; their fully remote U.S. team is lean, mission-driven, and growing quickly.

US

  • Lead the development and management of virtual care programs.
  • Manage and support a remote team of Nurse Practitioners.
  • Collaborate with cross-functional teams to optimize virtual care workflows.

Sprinter Health is an innovative healthcare startup dedicated to delivering high-quality, accessible in-home and virtual care across the country.

Canada 3w PTO

Accountable for the management, performance, quality improvement and scalability of our HCP contractor base. Work cross-functionally with Product, Medical Directors, Data, Regulatory, Patient Experience, and Pharmacy teams. Combine people leadership, operational rigour, analytical ownership, and applied AI/automation in a regulated healthcare environment.

Founded in 2019, Felix is a patient-driven digital healthcare company that puts you in control of your health and wellbeing.

US

  • Provide high-quality psychotherapy services with a focus on clinical decision making, and measurable outcomes.

Cerebral and Resilience Lab have joined forces to build a new standard in mental health care. By combining training with Cerebral’s extensive reach, clinical network, and care capabilities, they are creating a national model for high-quality, integrated, and accessible behavioral health care. Joining their team means committing to show up on your best foot every day where you’ll be equipped with structured training, supportive supervision, and a methodology designed to guide you in making sound clinical decisions.

US

  • Develop, manage, and execute global clinical studies.
  • Ensure timely and budget-compliant trial activities in accordance with quality standards.
  • Lead the selection and oversight of clinical trial sites.

This position is posted by Jobgether on behalf of a partner company.