What are the responsibilities and job description for the Utilization Management Specialist position at Samaritan Daytop Village, Inc.?
Job Summary
This position is responsible for ensuring compliance with external and internal utilization review/quality and appropriateness requirements. The successful candidate will have a strong background in behavioral healthcare/human services, quality assurance, and utilization review.
Duties and Responsibilities
- Conduct timely scheduled/required utilization reviews for Residential Services sites.
- Conduct timely and complete quality and appropriateness reviews on a representative sample of treatment records for residential service sites.
- Attend monthly/other required UR Committee meetings; Prepare accurate and timely UR Committee minutes and reports.
- Participate in the agency's Quality Improvement / Utilization Management Committee.
- Provide Supervisory support to CASAC Counselors and Peer Workers as needed with supervisory guidance from Management/Leadership Team.
- Monitor and evaluate ongoing audits for charts.
- Provide direct care services to clients as needed.
- Assist with the maintenance of the agency's OASAS accreditation for the program, i.e., standards review and conformance auditing.
Requirements
- OASAS CASAC Certification (with Bachelor's Degree); OR Other QHP credential such as LMSW, LMHC, LMSW-LP, or MHC-LP (with Master's Degree).
- Bachelor's Degree in Human Services; AND OASAS CASAC certification; OR Master's Degree in Social Work or related field; AND Other QHP credential such as LMSW, LMHC, LMSW-LP, or MHC-LP.
- At least One (1) year clinical or quality assurance experience in behavioral healthcare/human services organization or One (1) 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.
- Computer literacy including proficiency in Microsoft Office Suite and EHR.
- Experience working directly with people from diverse racial, ethnic, and socioeconomic backgrounds.
- Competency in written, interpersonal, verbal, and computational skills to present and document records in accordance with program standards.
- Ability to work independently.
