Clinical Quality Specialist (PT)

📋 Description Utilization Management & Review: conduct prospective, concurrent, and retrospective utilization Apply evidence-based UM criteria to evaluate clinical documentation and support authorization and Monitor care intensity and utilization trends to identify outliers and inform targeted provider Partner with health plans on external UR requests and peer-to-peer review coordination Clinical Quality & Provider Support: investigate and remediate provider concerns stemming from Monitor clinical adverse events and apply early-stage risk mitigation in partnership with 🎯 Requirements Master’s degree in a mental health discipline Active, cleared clinical license (e.g., LMFT, LPC, LCSW, LMHC, or equivalent) in good standing Experience in utilization management, utilization review, medical necessity review, or clinical Familiarity with payor requirements, medical necessity criteria, and level-of-care guidelines Strong clinical judgment and experience handling escalations, adverse events, or quality-related Demonstrated ability to produce clear, accurate, and defensible clinical documentation 🎁 Benefits Compensation: hourly rate $40-$42 per hour for up to 30 hours/week (part-time) Flexible schedule during normal business hours in your time zone Equal opportunity employer