Original listing text, shown exactly as published by the company.
About the Role
The Director of Clinical Quality serves as Equip's primary owner of clinical quality and patient safety, responsible for designing, implementing, and continuously improving clinical quality functions across Equip's virtual eating disorder program. This role drives operational excellence, evidence-based care standards, and a culture of safety and accountability — while also providing direct oversight of the Utilization Management (UM) program. The Director of Clinical Quality reports directly to the VP of Medical Operations & Quality and serves as the standing operational lead of the Clinical Quality Committee (CQC).
Responsibilities
- Design and oversee patient safety initiatives, safety reporting programs, and continuous clinical care improvement initiatives informed by safety data, audit findings, and peer review outcomes
- Provide oversight of clinical care standards across all disciplines — therapy, dietary, medical, and psychiatry — ensuring alignment with evidence-based eating disorder treatment standards.
- Develop and maintain clinical practice guidelines and documentation standards in partnership with discipline-specific leaders and the Compliance team.
- Lead clinical incident investigations and root cause analyses in collaboration with the Compliance team, developing and implementing risk mitigation strategies and monitoring patterns to identify systemic trends.
- Draft and revise clinical policies and procedures as informed by incident investigations, audit findings, and regulatory requirements, managing policies through the formal review and approval workflow. including CQC review and executive ratification.
- Identify and elevate ethical care considerations, provide decision-making support on complex cases, and escalate concerns to Legal and Compliance with appropriate documentation.
- Collaborate closely with Equip’s Data Insights & AI team to establish metrics and dashboards to track clinical quality metrics, translating data into actionable insights to drive improvements and contribute to long-term strategic planning for clinical quality.
- Serve as the standing operational lead of the CQC — preparing agendas, presenting quality data, and ensuring follow-through on committee decisions
- Design and continuously improve chart audit and peer review programs, analyze quality data, and translate findings into actionable insights and improvement initiatives for clinical and operational leadership.
- Provide direct oversight of the Utilization Management (UM) team, guiding UM team strategy by identifying and implementing operational process improvements and tracking KPIs to ensure consistent performance.
- Interface with external payor partners on utilization management processes and escalations.
- Perform other duties as assigned.
Qualifications
- Master’s degree or higher in a behavioral health or clinical field (e.g., MD/DO, MSW, MFT/LMFT, LPC/LP, PsyD, PhD, APRN, NP, RN with clinical leadership focus, or equivalent).
- Independent clinical licensure applicable to your setting (e.g., MD/DO, LCSW, LMFT, LP, LPC, RN, APRN)
- 8+ years of experience in behavioral health with demonstrated expertise in either clinical quality improvement, utilization management, or a meaningful combination of both within virtual/telehealth, managed care, integrated delivery, or provider-based settings.
- Demonstrated experience reviewing behavioral health clinical documentation and applying medical necessity criteria consistent with payer and regulatory requirements in a telehealth context.
- Demonstrated knowledge of evidence-based standards relevant to behavioral health; familiarity with telemedicine adaptations of these standards and familiarity with eating-disorder treatment is a plus.
- Direct experience designing or leading clinical quality programs in a virtual environment (e.g., chart audits, peer review, incident management, root cause analysis, policy/guideline development).
- 3+ years of progressive leadership experience, including people management of multidisciplinary teams (therapists, dietitians, physicians/apps, QM, UM, auditing, or compliance staff) in a remote or telehealth setting.
- Proven ability to balance patient, provider, and payor interests while upholding clinical and ethical standards in a virtual care model.
- Familiarity with governance structures (e.g., Clinical Quality Committee) and remote collaboration tools.
- Proficiency with telehealth platforms, EMR/eClinical systems, and digital chart review; ability to leverage data to drive quality improvement in a virtual environment.
- Familiarity with HIPAA privacy requirements and safeguarding confidential information in telehealth and cloud-based settings.
- Knowledge of payer policies for virtual behavioral health, telemedicine reimbursement considerations, and utilization management workflows within remote care.
- Understanding of regulatory and accreditation requirements impacting telebehavioral health (e.g., telemedicine compliance, state licensure compacts, and any relevant telehealth guidelines) and the ability to map these to clinical practice.
- Excellent ability to translate clinical data into actionable improvement initiatives across teletherapy, tele-dietary services, and psychiatric care, with buy-in from clinicians and app-based care teams.
- Strong collaboration skills with Compliance, Legal, IT/Product, Revenue Cycle, and Operations in a virtual ecosystem.
- Strong communication and interpersonal skills across internal and external stakeholders, with experience facilitating remote governance meetings, presenting quality and utilization data to executive audiences, and using dashboards and data visualization tools to drive accountable follow-through.
