Clinical Compliance & Utilization Review Spec

Unity House of Troy•City of Troy, NY

22h•Hybrid

About The Position

We are seeking a Compliance Specialist to conduct Utilization Review for New York State Office of Mental Health (OMH)–licensed clinical programs, including Assertive Community Treatment (ACT); Mental Health Outpatient Treatment and Rehabilitation Services (MHOTRS); Personalized Recovery Oriented Services (PROS); Crisis Residence programs; and other OMH‑licensed programs. This position is responsible for ensuring services are medically necessary, properly authorized, and delivered in compliance with OMH regulations, Medicaid requirements, and applicable accreditation standards. This role operates on a hybrid work schedule, with a combination of remote work and required in‑person presence.

Requirements

Must be a Licensed Practitioner of the Healing Arts (LPHA) in New York State (e.g., LCSW, LMHC, LMFT, Psychologist, Psychiatrist, Nurse Practitioner, or Physician Assistant), in good standing
Demonstrated knowledge of New York State OMH regulations, Medicaid Utilization Review requirements, and medical necessity criteria
Familiarity with OMH‑licensed services, including ACT, PROS, MHOTRS, Crisis Residences, and outpatient mental health programs
Strong written and verbal communication skills, including the ability to clearly document medical necessity and compliance findings
High attention to detail with the ability to review clinical documentation for accuracy, completeness, and regulatory compliance
Ability to work independently while collaborating effectively with clinical, administrative, and leadership staff
Proficiency with electronic health records (EHRs) and Microsoft Office applications
Ability to work on a hybrid schedule, including both remote work and required in‑person presence as needed

Nice To Haves

Experience conducting utilization review, chart audits, or compliance oversight within behavioral health or OMH‑licensed programs strongly preferred

Responsibilities

Conduct Utilization Review of clinical records to ensure medical necessity and level‑of‑care compliance
Monitor adherence to OMH regulations, Medicaid requirements, and program standards
Review admissions, continued stays, and discharges for compliance and documentation accuracy
Provide feedback and technical assistance to clinical staff regarding UM findings
Prepare reports and participate in audits, corrective action plans, and quality improvement activities

Benefits

13 paid days off in your first year for full time employment (increases every year)
56 hours of NYS Sick Leave
12 paid holidays plus 2 floating holidays
Major medical leave
Medical/dental/vision/life insurance
403b company contributions after one year of employment
Tuition reimbursement
50% reduction in childcare tuition at A Child's Place
Gym discounts
Tuition discounts
Cell phone discounts