Clinical Quality Assurance Specialist

Job Description

Job Description

Description:

Position Summary

The Quality Assurance (QA) Specialist ensures the delivery of high-quality, compliant, and data-driven behavioral health services across Crittenton’s programs. This role leads clinical chart audits, contract compliance reviews, performance monitoring, and data analysis to ensure compliance with LACDMH, Medi-Cal/CalAIM, DCFS, CDSS, and other regulatory requirements. The QA Specialist supports quality assurance and compliance efforts across Mental Health, Transitional Housing Programs (THP), and Foster Care services, translating data into actionable insights, strengthening audit readiness, monitoring contractual performance, and driving continuous quality improvement (CQI) initiatives that enhance outcomes, accountability, and service excellence.

Pay Range: $75,000.00 - $88,000.00 annually

Education / Experience Required

• Master’s degree in Social Work, Marriage and Family Therapy, Psychology, or related behavioral health field (required); licensed (LCSW, LMFT, LPCC) preferred.
• Minimum of 2-3 years of experience in quality assurance, data analysis, or clinical auditing within behavioral health or social service settings.
• Strong knowledge of LACDMH documentation standards, CalAIM, CDSS, and DCFS requirements.
• Experience working in PEI, Wraparound, Community Mental Health, ECM, Group Home, THP, Foster Care, Family Preservation, or similar programs required.
• Experience with EHR systems and Medi-Cal documentation standards required.
• Experience with data visualization tools (Power BI, Tableau, dashboards) preferred.

Clearances and Requirements

• Must successfully clear DOJ and FBI fingerprint checks.
• Must be at least 21 years of age.
• Valid California driver’s license and current auto insurance.
• Ability to work across office, residential, and field-based environments.
• Capacity to conduct site visits, audits, and quality inspections as needed.

Essential Duties

• Conduct ongoing audits of clinical documentation to ensure compliance with LACDMH, Medi-Cal, HIPAA, and contractual standards.
• Monitor contract compliance across programs, ensuring services align with funding requirements, service delivery expectations, and reporting obligations.
• Support quality assurance and compliance monitoring for THP, Foster Care, and other agency programs, ensuring adherence to DCFS, CDSS, and regulatory standards.
• Participate in LACDMH chart reviews and support organizational responses to corrective action plans.
• Train staff on documentation standards, medical necessity, and compliance expectations.
• Ensure ongoing compliance with DMH, CalAIM, HIPAA, The Joint Commission, Community Care Licensing, CDSS, and BBS standards.
• Maintain current knowledge of LACDMH QA bulletins, contract requirements, and regulatory updates across programs.
• Assist with preparation for external audits, licensing inspections, and accreditation reviews across mental health, THP, and foster care services.
• Support development and revision of agency policies to maintain compliance across all service lines.
• Collect, analyze, and interpret clinical, operational, and outcome data across multiple programs.
• Develop and maintain dashboards tracking KPIs, compliance indicators, and contract performance metrics.
• Identify trends, gaps in care, and compliance risks, and provide actionable recommendations to leadership.
• Produce reports, executive summaries, and performance metrics to support decision-making.
• Support development and monitoring of Key Performance Indicators (KPIs) related to quality, safety, documentation, and contract performance.
• Lead or support Continuous Quality Improvement (CQI) initiatives across mental health and related programs.
• Monitor progress of improvement initiatives and assist programs in implementing sustainable changes.
• Participate in root cause analyses (RCA) for incidents, complaints, and compliance issues.
• Monitor corrective action plans and evaluate effectiveness of interventions.
• Identify trends in incidents across programs and provide recommendations to reduce risk and improve service delivery.
• Maintain accurate, organized records of audits, findings, compliance activities, and corrective actions.
• Ensure all documentation is audit-ready for DMH, Medi-Cal, licensing, and accreditation reviews.
• All other duties as assigned.