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St. Joseph Medical Center

Quality Assurance & Staff Improvement

Career Insights for Clinical Auditor / Utilization Reviewer

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What they do

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.

$102,282 / year median in New York

-4% projected decline

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Job Description

JOB SUMMARY
: Maintain ongoing participation in the daily operation of the program through the provision of various clinical and therapeutic activities.
GENERAL DUTIES AND RESPONSIBILITIES
Assist in implementing the established program policies, mission and procedures, as they relate to client services. Provide treatment services to assigned clients. Responsible for managing quality improvements, utilization review for
SJMC/OTP
Coordinates, facilitates and tracks Quality Improvement activity for
SJMC/OTP
Prepares for program recertification, surveys and audits. Ensures compliance with regulatory agencies by assisting in the preparation for and participating in audits and surveys (e.g. OASAS, JCAHO, etc.) Ensures excellence in clinical practice and delivery of patient care by monitoring the implementation of the department's QI Plan through the use of audits, tracers, PDCA, Consumer Satisfaction Survey and other methods. Ensures appropriate utilization of opioid treatment resources by monitory and reviewing admissions and discharges of all OTP clients. Provides Utilization Review and Quality Improvement Training to staff as necessary. Preforms unannounced random chart review of all OTP to ensure quality and overall compliance of both state and federal regulations as well has hospital policies. Maintain confidentiality of all client information as required by law. Competent to work with patients appropriate to the setting of the agency regarding age and special populations. Maintain knowledge of OASAS regulations and new developments in a changing health care environment. Maintain all applicable certificates and licensure. Maintain a current knowledge of reimbursement methods such as managed care, Medicaid and commercial insurance. Work as a team player in all areas to enhance the program as a whole. Represent our agency with an ethical, fair and positive attitude. Assist in supervising clinical staff as assigned Responsible for facilitating and leading peer supervision Any other duties as assigned.
QUALIFICATIONS
CASAC Required Preferred
LMSW/LCSW/LMHC
Two (2) or more years' experience in Alcoholism or Substance Abuse Treatment. Knowledge with Opioid Treatment/MMTP modalities and/or 822 clinic modalities Full Time Day Shift 6AM-2PM Salary Range $68K-$78
K Shift:
Days Compensation:
$68k-$78k