Clinical Review Manager

Gaudenzia, Inc.•Washington, DC

About The Position

Gaudenzia's Mission is to promote long-term recovery by providing comprehensive treatment and support to people with substance use disorder, co-occurring mental health disorders, and related conditions, regardless of individual circumstances. Gaudenzia is proud to be an employer of choice - and a treatment provider of choice - in the substance use and co-occurring disorders treatment field. We work hard to foster an inclusive, supportive environment where our employees and clients always feel safe and welcome.

Requirements

High School Diploma or GED
5+ years of billing in substance use disorder or mental health industry
Working knowledge of managed care, government funders a must, with experience in billing, utilization and review of the DC market
Knowledge of Managed Care, including DC and Comagine preferred
Knowledge of regulatory, licensing, and accreditation standards
Knowledge of utilization review process
Knowledge of substance use and mental health disorder treatment programs
Knowledge of quality improvement processes, including the ability to evaluate and recommend changes to enhance service quality
Ability to communicate effectively, both verbally and in writing
Ability to successfully work with others from various cultures and backgrounds
Ability to plan and organize work and prepare appropriate, accurate records, and reports
Ability to establish and maintain effective working relationships with clients, staff, health care providers, referral entities, outside agencies, institutions and the general public.

Nice To Haves

College Degree preferred

Responsibilities

Treat all clients and staff with dignity and respect
Supervise audit and review process and provide documented recommendations based on appropriate guidelines
Review and approve documentation associated with applicable state regulations, insurance requirements, and relevant treatment guidelines
Ensure accurate, up-to-date records, including intake, records of referral, and funding source documentation are compiled and stored within the electronic health record system within the required timeframes.
Assist clinical staff in quality improvement projects by providing instructive feedback
Resolve client care issues by working one-on-one with community providers and staff to address issues in the determination process
Establish and maintain positive relationships with funding, referral, and regulatory agencies
Provide information by responding to queries from funding sources, sorting and distributing messages and documents, and preparing information for determinations
Improve quality results by studying and evaluating procedures, and processes, and recommending changes if needed
Other duties as assigned by the Operations Director, or designee