Utilization Manager

Responsibilities

• Counsels and supervises staff as needed with assuring compliance with external and internal utilization review/quality and appropriateness requirements.
• Conducts 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 required 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.
• Maintains oversight of ongoing audits for charts.
• Assists with the maintenance of the agency’s OASAS accreditation for the program, including standards review and conformance auditing.
• Performs other duties as assigned.

Qualifications

• A High School Diploma or GED is required, with higher education in the human services field preferred.
• Must have at least one year of clinical or quality assurance experience in behavioral healthcare/human services organization or one year of demonstrated clinical experience in substance use or mental health treatment.
• Must have in-depth knowledge of HIPAA, OASAS, and 42 CFR regulations.
• Must have working knowledge of quality assurance and utilization review systems.
• Must be proficient in Microsoft Office Suite and EHR systems.
• Must have experience working with people from diverse racial, ethnic, and socioeconomic backgrounds.
• Must have strong written, verbal, and interpersonal communication skills.
• Must have the ability to accurately document records according to program standards.
• Must have the ability to work independently.
• Spanish bilingual skills are a plus.