Find & Apply For Clinical Auditor / Utilization Reviewer Jobs in Decatur, Georgia

Company Overview CaringWorks is a nonprofit 501(c)3 organization dedicated to ending homelessness. We provide personalized, respectful care that recognizes each individual's potential for success, going beyond standard housing and services to meet unique needs. Job Overview The Behavioral Health Tier II Program Utilization Manager oversees service utilization, care coordination efficiency, and regulatory compliance for Tier II behavioral health programs serving individuals with moderate to high acuity needs. This role ensures that service delivery is clinically appropriate, person‑centered, cost‑effective, and aligned with state, federal, and accreditation standards. The Utilization Manager requests and monitors authorization processes, reviews clinical documentation, analyzes utilization trends, and collaborates with interdisciplinary teams to optimize access, quality, and outcomes. Responsibilities

• Monitor utilization patterns across Tier II services, including individual and family therapy, psychiatric services, case management, psychosocial individual services, and ADSS.
• Create initial and ongoing service authorizations in funder databases and enter authorization information in the Notenetic system.
• Review service authorizations, medical necessity criteria, and level-of-care determinations for alignment with payer requirements.
• Conduct ongoing utilization reviews to prevent overuse or underuse of services and support timely, appropriate care.
• Track service frequency, duration, and intensity to maintain compliance with Tier II program standards.
• Conduct brief reviews and upload of treatment plans in Notenetic.
• Review clinical documentation for completeness, accuracy, and compliance with regulatory and accreditation standards, including CARF, DBHDD, Medicaid, and HIPAA.
• Participate in internal audits, chart reviews, and quality improvement initiatives.
• Conduct monthly quality assurance calls to verify that client service needs are being met.
• Complete internal discharge summaries, transition plans, and discharge entries in required databases.
• Support preparation for external audits, surveys, and compliance reviews.
• Perform other duties as assigned. Requirements
• Master's degree in a mental health field required; LMSW or LAPC credential preferred.
• At least two years of experience in Core/Tier II behavioral health programs required.
• Knowledge of Core/Tier II Medicaid services, service codes, and modifiers required.
• Strong clinical judgment and decision-making skills required.
• Knowledge of and ability to utilize proven customer services strategies including effective listening, problem-solving, monitoring workflow, meeting deadlines, and timely follow-up.
• Must successfully pass a background check and drug screen/test.

Join our team as a Behavioral Health Utilization Manager to make a meaningful impact by coordinating vital behavioral health services that promote recovery and well-being for our community members.

REQUIRED SKILLS

• Strong written and verbal business communication skills, including the ability to prepare and format memos, letters, and reports.
• Ability to work effectively with at-risk client populations, including individuals experiencing chronic illness, mental illness, or substance use challenges.
• Proven ability to manage time, prioritize tasks, and stay organized.
• Excellent interpersonal, customer service, and problem-solving abilities.
• Ability to multitask, organize projects, and provide project support.
• Proficiency in Microsoft Office, including Word and Excel.
• Ability to work independently while managing multiple priorities.

PREFERRED SKILLS

• Efficiency in Google Docs/Google Drive /PowerPoint.

Pay:

$60,000.00 - $63,000.00 per year

Benefits:

Dental insurance Health insurance Paid time off Vision insurance

Work Location:

In person