Healthcare Utilization & QA Manager

The Role: In concert with the agency's mission and goal of sustaining high quality care/service delivery to persons served, the Utilization Manager works to assist CASAC Counselors and supervisory staff as needed with assuring compliance with external and internal utilization review/quality and appropriateness requirements.

Responsibilities: What You Will DoConducts timely scheduled/required utilization reviews for Residential Services sites. Conducts timely and complete quality and appropriateness reviews on a representative sample of treatment records for residential service sites. Attends monthly/other require UR Committee meetings. Prepares accurate and timely UR Committee minutes and reports. Participates in the agency's Quality Improvement / Utilization Management Committee. Provides Supervisory support to CASAC Counselors and Peer Workers as needed with supervisory guidance from Management/Leadership Team. Monitors and evaluates ongoing audit for chart. Provides direct care services to clients as needed. Assists with the maintenance of the agency's OASAS accreditation for the program, i.e., standards review and conformance auditing. Performs other duties as assigned.

Qualifications: Who You Will BeHigh School Diploma or GED required, higher education in the human services field, preferred Current CASAC or the ability to complete requirements to obtain a CASAC (T) within 6 months of hire At least one year of clinical or quality assurance experience in behavioral healthcare/human services organization or one year demonstrated clinical experience in substance use or mental health treatment In depth knowledge on HIPAA, OASAS, and 42 CFR regulations Working knowledge of quality assurance and utilization review systems Proficient in Microsoft Office Suite and EHR systems. Experience working with people from diverse racial, ethnic, and socioeconomic backgrounds. Strong written, verbal, and interpersonal communication skills. Ability to accurately document records according to program standards. Ability to work independently. Spanish bilingual skills are a plus. li-onsite