Quality Assurance Reviewer

Alliant Health Solutions

. Conduct quality assurance reviews and monitor policy compliance for the South Carolina Department of Disabilities and Special Needs Quality Assurance Review program .

Posted 10/17/2026full-timeColumbia • South Carolina • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in quality assurance reviews and compliance monitoring within the South Carolina Department of Disabilities and Special Needs framework. Proficient in conducting interviews, analyzing data, and preparing comprehensive reports while maintaining confidentiality and adhering to HIPAA regulations.

Highest-signal resume keywords

Quality AssuranceCompliance MonitoringClinical Rationale AnalysisInterpersonal CommunicationMedGuard Review System

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Quality AssuranceCase ManagementClaims AuditingData EntryDesk ReviewsOn-Site ReviewsReport PreparationPolicy ComplianceExcelWord

Soft Skills

Interpersonal SkillsWritten CommunicationVerbal CommunicationProblem ResolutionTeam Collaboration

Tools & Technologies

MedGuard Review SystemMicrosoft ExcelMicrosoft Word

Certifications & Qualifications

Registered Nurse LicenseSocial Worker License

Industry Keywords

South Carolina DDSNMedicaidMental Health Utilization ReviewDevelopmental DisabilitiesHIPAA Compliance

About the role

Key responsibilities & impact

Conduct quality assurance reviews and monitor policy compliance for the South Carolina Department of Disabilities and Special Needs Quality Assurance Review program
Perform desk reviews by analyzing previous review findings and developing the appropriate approach for on-site reviews
Conduct on-site reviews of specified SC DDSN providers
Conduct entrance and exit sessions with provider management and clinical staff
Conduct staff interviews, consumer interviews, and document reviews
Notify providers in advance of upcoming on-site visits
Inform providers of the purpose of visits and preliminary findings
Make recommendations regarding compliance with SC DDSN standards, service necessity and quality, and appropriateness of settings
Substantiate recommendations with clinical rationale
Analyze, interpret, and document review outcomes using the MedGuard review system
Prepare timely and accurate written letters and reports for providers and SC DDSN
Review follow-up review information and recommend appropriate actions
Occasionally serve on peer panels to provide professional expertise regarding service delivery standards
Collaborate with team members on new projects and continuous improvement
Promote teamwork, professionalism, effective communication, and positive behavior
Perform other duties as assigned

Requirements

What you’ll need

Bachelor's degree in social work, Sociology, Psychology, Nursing (BSN) or other Human Services degree
Minimum of 3 years of previous SC DDSN, Medicaid, Mental Health Utilization Review, Case Management, Quality Assurance, Claims Auditing, and/or Fraud/Abuse experience
Moderate computer skills, including Excel and Word
Word-processing speed of 30–50 WPM
Data entry skills
Excellent interpersonal, written, and verbal communication skills
Excellent telephone skills, including ability to handle difficult calls/callers
Ability to travel by car or plane to company locations, customer meetings, or other locations as needed
Preferred but not required: Registered Nurse or Social Worker with current and unencumbered South Carolina license
Preferred but not required: Previous clinical experience working with individuals with developmental disabilities
Ability to maintain security and confidentiality in accordance with HIPAA laws, regulations, and company policies
Ability to work with considerable independence, prioritize work, analyze problems, and use innovative approaches to problem resolution
Ability to remain stationary regularly and occasionally move about the office
Ability to move or transport materials weighing up to 30 pounds occasionally
Ability to understand and exchange accurate information through face-to-face, electronic, and telephone communication
Core office/business operational hours may be required

Benefits

Comp & perks

HIPAA-compliant health information confidentiality protections
Reasonable accommodation process for disabilities under ADA/ADAAA/Section 503
Professional office environment and use of standard office equipment