Quality Improvement Specialist

What you’d do

Reviews behavioral health claims before payment, checking clinical records and documentation against medical necessity, regulatory, contractual, and billing requirements, then recommends payment, denial, or further review. Full-time remote role open to residents of listed states. Found on the employer's careers page on Oct 18, 2026. Apply through the link.

You’ll need

• Knowledge of behavioral health diagnoses and levels of care
• Knowledge of Medicaid behavioral health regulations
• Medical necessity criteria experience
• Ability to interpret clinical records
• Reside in an approved state