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TW
The Wisdom Center
Clinical Quality Reviewer
Career Insights for Clinical Auditor / Utilization Reviewer
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Based on California data
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What they do
A Clinical Auditor or Utilization Reviewer reviews the efficiency of healthcare delivery. Individuals tend to have had experience as a registered nurse or other healthcare delivery roles before transferring into this quality review role.
$118,997 / year median in California
-4% projected decline
Job Description
Wisdom Adult Day Partners is seeking an experienced LCSW, RN, or LVN to support the quality and effectiveness of our Enhanced Care Management program. The Clinical Quality Reviewer will review member assessments, reassessments, care plans, and progress notes to ensure that member needs are identified, care plans are meaningful and prioritized, and documentation reflects effective care management. The reviewer will provide Lead Care Managers with clear guidance regarding care-plan priorities, needed interventions, documentation corrections, and follow-up. This is a clinical quality and care-management guidance role , not a direct staff-supervision position. Key Responsibilities Review ECM assessments, care plans, reassessments, and progress notes. Identify missing needs, barriers, interventions, or required follow-up. Provide clear, constructive guidance and documentation corrections to LCMs. Assist with complex or returned reassessments. Participate in case consultation and care-plan review. Identify recurring quality concerns and staff-training needs. Support improvements to ECM assessment, care-plan, and documentation tools. Qualifications Current, active California license as an LCSW, RN, or LVN . Significant experience in care management, complex case management, behavioral health, medical case management, or clinical quality review. ECM/CalAIM experience strongly preferred. Strong knowledge of person-centered care planning, medical and behavioral health coordination, LTSS, community resources, and social determinants of health. Excellent documentation, analytical, and communication skills. Ability to provide clear and constructive direction while working within professional scope of practice. Excellent understanding of EHR and computer documentation, Google suite. This position may be performed remotely within California, with periodic onsite attendance in Santa Maria as needed. Wisdom Adult Day Partners is an equal opportunity employer. Reasonable accommodations are available to qualified applicants and employees with disabilities. Qualified applicants with criminal histories will be considered in accordance with the California Fair Chance Act.