A Clinical Auditor or Utilization Reviewer reviews the efficiency of healthcare delivery. Individuals tend to have had experience as a registered nurse or other healthcare delivery roles before transferring into this quality review role.
Charlotte, NC Job Details Full-time $45,000 - $50,000 a year 10 hours ago Qualifications Client assessment in therapy Client assessment in social work HIPAA Driver's License Substance abuse counseling Direct support Clinical confidentiality policies Experience working with individuals with substance use disorders Substance abuse services in social work Full Job Description
JOB SUMMARY
Responsible for developing initial PCPs and Crisis Plans for all new admits. The Intake Assessor will work closely with the Billing Specialist to ensure the timely completion of all CCA needed for initial and re-authorizations. Collaborates closely with clinical, billing, and administrative, to meet organizational goals, including census targets, compliance standards, and quality assurance.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Coordinate admissions, conduct phone interviews, develop PCPs and Crisis Plans, sign Medicaid PCPs, manage census and capacity reporting, room assignments, coordinate with maintenance, and complete discharge reviews. Complete CCAs for admissions and reauthorizations as needed. Screen clients for appropriateness for program entry (processing referrals).
Complete pre-assessment:
Diagnosis, History of treatment SA and MH, Target Population and justification for residential services Coordinate with Intake Specialist regarding perspective applicants Review and reassess past residents for readmission into Hope Haven Conduct admission screenings and determine appropriateness for services. Complete interviews and admission documentation. Coordinate admissions with referral sources and treatment staff. Develop and complete initial Person-Centered Plans (PCPs) for all new admissions. Ensure PCPs are completed within required timelines. Monitor compliance with SAIOP and SACOT service definitions and documentation requirements. Conduct chart audits and track treatment plan reviews, authorizations, and service requirements. Monitor bed availability, waitlists, and occupancy trends. Participate in quality improvement, utilization review, and audit preparation activities. Collaborate with clinical, nursing, residential, and administrative staff. Email nursing/medical staff when new admissions PCP/Crisis Plans are completed and signature is needed. Maintain compliance with agency policies, procedures, and standards, upholding organizational values and regulatory requirements. Assist compliance with internal and external audits. Review Medicaid enrollments/eligibility monthly. Other duties as assigned; not limited to these.
POSITION QUALIFICATIONS
Currently licensed by NCSAPPB or certified by another state as an alcohol/drug counselor, or currently in the final stage of the certification process and become certified within one (1) year of employment. Master's degree in social work, Counseling, Psychology, or related field required. Licensed Associate (LCASA, LCMHCA, LCSWA, or equivalent) strongly preferred. Minimum two years of experience working with individuals with SUD. Knowledge of ASAM Criteria, Person-Centered Planning, SAIOP, SACOT, and residential treatment services preferred. Individual must have a working knowledge of the principles and techniques in the counseling and care of all residents, including the 12 core functions of counseling, especially screening, intake, orientation, assessment and referral. If appropriate, minimum two (2) year's continuous sobriety and/or recovery from mood altering drugs. Recovery from alcohol or other drug(s) must be always maintained, with active involvement in a program of recovery. Individual must complete and maintain all required trainings as listed by Human Resources according to state licensure for Hope Haven. Strong organizational, communication, and documentation skills. Willingness and ability to provide direct support and coverage within the facility on a 24/7 basis as operational needs require. Excellent written and verbal communication skills. Knowledge of the dynamics of the disease of addiction and its treatment. Must know confidentiality laws so that client confidentiality is always maintained Adhere to all HIPPA and confidentiality rules and guidelines. Cause no harm to self and others on-site or off-site (includes, physical, or psychological). Must have a valid driver's license and be insured by Hope Haven's carrier.
