Utilization Reviewer

Pay is commensurate with experience within a range of $65,000 to $70,000 annually. Full time, exempt, benefits eligible. Bert Nash offers excellent benefits which include medical, dental, vision, KPERS retirement, life insurance, an Employee Assistance Program (EAP) providing free counseling and resources, and generous PTO.

Caring. Hope. Giving back. Our mission at the Bert Nash Center as the Community Mental Health Center (CMHC) of Douglas County is to advance the health of the community through comprehensive behavioral health services responsive to evolving needs and changing environments. We accomplish this by believing in our team. Each person that works for the Bert Nash Center contributes directly to the success of our clients, organization, and community. Our values of compassion, integrity, equity and hope reflect in everything we do.

The Utilization Reviewer's primary responsibility is to manage and complete monthly clinical record reviews to ensure provision of clinically appropriate care is delivered to clients in the least restrictive but clinically appropriate level as quickly as possible while complying with agency, payers, applicable policies, regulations and accreditation standards. This role's overall goal is to ensure that quality services are provided in the most efficient, cost-effective manner to all eligible clients seeking treatment regardless of the treatment setting or payer.

Responsibilities:  The primary responsibility of the Utilization Reviewer is to ensure clinical documentation achieves expected standards, implement and train for consistency in best practices across the organization's facilities, participate and coordinate with teams Quality Improvement Plans or related initiatives. Duties will include but not limited to:

• Conduct monthly clinical chart reviews to assure clients receive clinically appropriate care and complies with agency, payor, applicable policies, regulations and accreditation standards.   
• Utilize evidence-based calculation to ensure the sample size of charts reviewed provide a high confidence level that results are valid and reliable.
• Provide chart review results to program directors or managers with both aggregate program data and individual charts needing remediation.
• Work with directors or program managers on remediation activities to ensure they are completed within 30 days.
• Meet with teams to help identify and develop continuous quality improvement goal(s) to improve the quality of documentation.
• Managing organizational risks through implementation and improvement of best practices in clinical documentation, CCBHC regulations, CARF standards and other regulatory requirements.
• Provide or coordinate the provision of related trainings in collaboration with the Clinical Consultant, Clinical Educator, and other team members.
• Provides response to clinical quality questions.
• Champions continuous quality improvement and assists in developing, tracking, and realizing related organizational goals or objectives.
• Assign, analyze and present the quarterly chart review data for all teams per CARF Standards 2.G. and 2.H.
• Analyzes monthly chart reviews to identify both areas needing improvement and areas that have improved since previous audits.
• Maintain and record inventories of chart review occurrences and results.

Qualifications include but not limited to:

• Licensure in social work, counseling, nursing or psychology.
• Knowledge and familiarity with electronic health record (EHR) documentation.
• Three years of experience providing billed services to clients in fields such as nursing, counseling, psychology, therapy, medication management, case management, or other.
• Master's degree in behavioral health, medical services or administration, nursing, psychology, sociology, or similar.
• Ability to accurately interpret standards from policies, contracts, and accrediting bodies for implementation.
• Flexibility in assigned working hours.
• Ability to negotiate, complete contracted work, analyze operations, and governmental/accrediting body regulations.
• Interest or experience in quality improvement, quality assurance, or similar background and/or training a plus.
• Have exemplary existing skills in clinical documentation and familiarity with using EHRs to complete documentation reviews, as well as external tools such as the Microsoft Office Suite.
• Assist QI team with other duties as needed.

Salary : $65,000 - $70,000