Clinical Specialist, Quality Management & Performance

Responsible for overseeing quality systems and regulatory compliance within state, federal, and accreditation bodies. Through standard operating procedure review and internal audits, they are responsible for identifying discrepancies, ensuring adherence to clinical policies, and safeguarding the reliability of clinical data. They collaborate closely with clinical teams, regulatory bodies, and accreditors. The specialist’s focus is continuous clinical improvement and regulatory excellence.

Ensures compliance with state, federal, NCQA, and URAC standards. Conduct internal and external audits of clinical programs. Prepare and present quality assurance reports Monitor clinical trial activities to ensure adherence to protocols Train clinical staff on regulatory requirements and quality standards Assists with staff training materials and software development to ensure use of up-to-date evidence-based resources. Identify and manage risks related to clinical quality Review and approve Standard Operating Procedures Collaborate with cross-functional teams to resolve quality issues Maintain up-to-date knowledge of industry standards and regulations Stay current with evidence-based practice models and current processes to provide staff instruction. Other related duties as assigned to meet departmental and Company objectives Attend and participate in all mandatory department and training meetings as assigned by management. Comfort level in Microsoft suite and Smart Sheet Participates in case file preparation and mark-up for audit Ability to pass external audits to include URAC and NCQA. Maintain HIPPA compliance per company’s policy and procedures. Maintain confidentiality and minimum requirement rules. Complete all required yearly training per company’s expected period.