Clinical Review Specialist

Job Summary
We are seeking a dedicated and detail-oriented Clinical Review Specialist to oversee and ensure adherence to regulatory standards and internal policies within our organization. The ideal candidate will possess a strong background in compliance management. This role is crucial in maintaining the integrity of our operations and supporting our commitment to quality assurance.

Approximate start date: September 21, 2026 - October 19, 2026

Duties

• Facilitate file management and collections of records for external audits and record review by DBHDS, MCO’s, DMAS, etc as well as respond to CAP and QIP submittals.
• Implements initiatives needed to adhere to compliance standards as outlined in corrective action plans and quality improvement plans.
• Complete ongoing surveying, QA data collection, and QA review; discuss findings and areas for opportunity with CEO.
• Complete quantitative and qualitative record reviews in conformance with CARF; discuss findings and areas for opportunity with CEO.
• Complete targeted studies and analysis of the organization’s clinical and program processes and outcomes; discuss findings and areas for opportunity with CEO.
• Review and update company policy and procedures as necessary to meet DBHDS, DMAS, and CARF standards in collaboration with clinical teams, Operations Director, and CEO.
• Review and update clinical processes as necessary to maintain compliance with applicable policies and procedures in collaboration with clinical teams and CEO.
• Identifies general opportunities for program improvement and advises Operations Director and CEO of appropriate action.
• Designs and implements programs and practices as necessary to ensure that organization complies with CARF, HIPAA, Human Rights and Ethics.
• Institutes the standard of conduct that outlines appropriate behaviors and practices within the organization.
• Provide onboarding and annual retraining on Clinical Documentation, Human Rights, Risk Management, Infectious Disease Control, Disaster and Emergency Preparedness, and Ethics to all staff.
• Develop and oversee employee training programs and materials on compliance and risk management guidelines.
• Responsible for risk management functions and service as Risk Manager for the organization.
• Completion of DBHDS department approved training which shall include training related to risk management, human rights, risk screening, conducting internal investigations, root cause analysis, and the use of data to identify risk patterns and trends.
• Sustain improvements through staff education, training, and technical assistance as needed to address identified areas for opportunity to further support staff professional growth, performance, and job readiness.
• Conduct systemic risk assessment reviews at least annually to identify and respond to practices, situations, and policies that could result in the risk of harm to individuals receiving services.
• Review and update risk management plan at least annually or as needed based on ongoing quality review and risk management activities, such as during quarterly reviews of all serious incidents.
• Implement agency’s written risk management plan to identify, monitor, reduce, and minimize harms and risk of harm, including personal injury, infectious disease, property damage or loss, and other sources of potential liability.

Experience

• LMHP certification from the Virginia Board of Counseling required.
• A minimum of 10 years’ experience in the human services field.
• Experience reviewing and maintaining large quantities of files and records.
• Excellent leadership skills and strong ability to take initiative.
• Strong organizational skills and ability to self-direct.
• Ability to meet deadlines.
• Ability to maintain confidentiality.
• Ability to prioritize, multi-task, and produce high quality and accurate work.

Pay: From $80,080.00 per year

Education:

• Master's (Required)

License/Certification:

• LMHP license issued by the Virginia Board of Counseling (Required)

Ability to Commute:

• Richmond, VA 23219 (Required)

Work Location: In person

Salary : $80,080