Quality Manager, Behavioral Health

Job Description:

• Develop, implement, and manage behavioral health quality assurance and quality improvement processes across therapy and psychiatry services
• Develop and maintain chart audit processes evaluating clinical documentation, treatment planning, medical necessity, risk assessment, coding support, and compliance
• Monitor documentation timeliness, completeness, and quality; identify trends and support improvement with clinical and operational leaders
• Conduct documentation reviews and provide actionable feedback to providers
• Develop and implement clinical documentation standards, templates, workflows, and audit tools
• Track and evaluate quality metrics including clinical outcomes, PHQ-9 and GAD-7 measurement cadence, symptom improvement, patient satisfaction, access, complaints, incidents, and provider performance
• Create quality scorecards, dashboards, audit tools, reports, and outcome measurement processes
• Analyze quality data and prepare summaries with findings, recommendations, and action plans
• Support payer, regulatory, accreditation, and internal audit readiness
• Identify risks, close process gaps, strengthen quality controls, and support investigations and corrective actions
• Review complaints, grievances, incident reports, safety concerns, adverse events, and clinical risk matters
• Collaborate on peer review, case review, provider education, documentation feedback, and performance improvement
• Provide clinical quality guidance on documentation, evidence-based care, workflows, care coordination, and high-risk patient management
• Support provider onboarding, training, coaching, and ongoing education
• Support standardized workflows for referrals, scheduling, documentation, treatment plans, high-risk patient management, crisis escalation, care coordination, and follow-up
• Lead or participate in quality committees, workgroups, audits, performance improvement projects, and change management initiatives
• Apply structured problem-solving methods to identify root causes and support sustainable improvements
• Collaborate cross-functionally with behavioral health operations, clinical leadership, compliance, revenue cycle management, data analytics, product, customer service, credentialing, and other teams
• Support behavioral health policies, procedures, workflows, scorecards, outcome measures, and performance monitoring processes
• Potentially supervise Quality Assurance staff or designated team members, providing leadership, training, mentorship, and accountability

Requirements:

• Bachelor’s degree in healthcare administration, public health, behavioral health, social work, counseling, nursing, psychology, or a related field
• 5–8 years of relevant experience in healthcare quality management, behavioral health operations, clinical quality assurance, compliance, or related healthcare settings
• Experience with behavioral health documentation standards, chart audits, treatment plans, medical necessity, risk assessment, and payer audit expectations
• Knowledge of quality assurance and quality improvement principles, methods, and tools
• Experience collecting, reviewing, analyzing, and interpreting clinical, operational, and quality data
• Strong understanding of telehealth, outpatient behavioral health service delivery, and integrated or collaborative care models
• Ability to develop workflows, audit tools, policies, procedures, reports, scorecards, and improvement plans
• Strong organizational skills with the ability to manage multiple priorities, deadlines, and cross-functional projects
• Excellent written and verbal communication skills, including the ability to provide clear documentation feedback and present findings to leadership
• Ability to work collaboratively with clinical providers, operational leaders, compliance, revenue cycle management, product, data, credentialing, and customer service teams
• Proficiency with Microsoft Office applications and comfort working with electronic health records and reporting tools
• Preferred: Active clinical license in VA, DC, or MD — LCSW-C, LICSW, LPC, LCPC, or LMFT
• Preferred: Experience delivering behavioral health services via telehealth
• Preferred: Experience with Athena or similar electronic health record systems
• Preferred: Experience supporting payer audits, regulatory reviews, complaint and grievance processes, incident review, or corrective action plans
• Preferred: Familiarity with PHQ-9, GAD-7, outcome measurement, provider performance metrics, and clinical quality dashboards
• Preferred: Experience providing clinical consultation, provider support, mentoring, supervision, or quality leadership within behavioral health settings