Job Description
Job Description
ROLE: The Clinical Quality Manager (CQM) holds an integral position on our clinical team, working to ensure a high level of clinical quality on assessments and documentation. The CQM will review reports, provide feedback to BCBAs, and identify strategies for providing effective training and support. The Clinical Quality Manager works in collaboration with the Director of Assessment as well as with other Clinical Quality Managers, Case Managers, Clinical Directors and BCBAs.
RESPONSIBILITIES (Include, but are not limited to):
? Review and provide feedback on assessment reports written and submitted by our BCBAs.
? Assist BCBAs in updating their assessments to ensure they meet insurance requirements and gain
approval.
? Collect signatures on documentation as needed
? Report on insurance trends. Update Assessment templates based on changes to insurance regulations.
? Keep track of open authorizations to ensure there are no lapses in coverage and assessments are
submitted on time.
? Liaise with the Case Manager if assessments were not submitted on schedule
? Liaise with insurance to resolve a denial. Assist with insurance calls and peer reviews as needed.
? Meet as needed with Regional Directors to report issues that are seen with the assessments.
? Meet weekly with the Director of Assessment
? Report updates on assessment trends and updates to insurance guidelines.
REQUIREMENTS:
Qualifications: BCBA with a minimum of one year of experience working within ABA and the insurance model;
strong interpersonal and communication skills; must be able to deliver constructive feedback; excellent
computer skills; detail-oriented; ability to work independently and manage tight deadlines; dedication to
ensuring the highest quality of care for individuals with autism and developmental disabilities.
Skills: Strong writing skills, ability to provide constructive feedback, experienced and confident in coaching
others, pattern recognition, critical thinking and analytic skills, ability to identify and implement solutions, ability
to organize materials and resources, and strong interpersonal skills.
Supervision: The Clinical Quality Manager reports directly to the Director of Assessments.
Work Schedule: 36-hour general weekly schedule.
Monday-Thursday from 9 AM - 5 PM
Fridays from 9:00-1:00 PM
Work Environment: Work will be performed in the office or remotely. In-office candidates are preferred. Must
have access to computer, internet, and reliable equipment for completion of job tasks. Space should be free from excessive noise or distraction.
Communication Skills: Advanced written, oral, and interpersonal skills. Compelling communication style to
advocate for client needs.
Computer Skills:
Proficiency in Outlook, Word, and Excel.
Reasoning Ability: Ability to make determinations of best procedures and practices to attain goals of the
position.
Working Conditions: This is an exempt, salaried position, where regardless of hours worked, the goals of the work is completed in its entirety.
Physical Demands: Ability to perform extended desk-work, and handle the necessary physical demands of
actively supporting, lifting, and working in indoor and/or outdoor settings. This includes, among others, sitting,
kneeling, crawling, and lifting up to 25 lbs, as needed.