Clinical Compliance & Utilization Review Spec

We are seeking a Compliance Specialist to conduct Utilization Review for New York State Office of Mental Health (OMH)licensed clinical programs, including Assertive Community Treatment (ACT); Mental Health Outpatient Treatment and Rehabilitation Services (MHOTRS); Personalized Recovery Oriented Services (PROS); Crisis Residence programs; and other OMHlicensed programs. This position is responsible for ensuring services are medically necessary, properly authorized, and delivered in compliance with OMH regulations, Medicaid requirements, and applicable accreditation standards. This role operates on a hybrid work schedule, with a combination of remote work and required inperson presence.

Key Responsibilities Conduct Utilization Review of clinical records to ensure medical necessity and levelofcare compliance Monitor adherence to OMH regulations, Medicaid requirements, and program standards Review admissions, continued stays, and discharges for compliance and documentation accuracy Provide feedback and technical assistance to clinical staff regarding UM findings Prepare reports and participate in audits, corrective action plans, and quality improvement activities QualificationsMust be a Licensed Practitioner of the Healing Arts (LPHA) in New York State (e.g., LCSW, LMHC, LMFT, Psychologist, Psychiatrist, Nurse Practitioner, or Physician Assistant), in good standingDemonstrated knowledge of New York State OMH regulations, Medicaid Utilization Review requirements, and medical necessity criteriaExperience conducting utilization review, chart audits, or compliance oversight within behavioral health or OMHlicensed programs strongly preferredFamiliarity with OMHlicensed services, including ACT, PROS, MHOTRS, Crisis Residences, and outpatient mental health programsStrong written and verbal communication skills, including the ability to clearly document medical necessity and compliance findingsHigh attention to detail with the ability to review clinical documentation for accuracy, completeness, and regulatory complianceAbility to work independently while collaborating effectively with clinical, administrative, and leadership staffProficiency with electronic health records (EHRs) and Microsoft Office applicationsAbility to work on a hybrid schedule, including both remote work and required inperson presence as needed

Benefits:

13 paid days off in your first year for full time employment (increases every year)56 hours of NYS Sick Leave12 paid holidays plus 2 floating holidaysMajor medical leaveMedical/dental/vision/life insurance403b company contributions after one year of employmentTuition reimbursement 50% reduction in childcare tuition at A Child's Place.

Plus, gym, tuition and cell phone discounts Come work for an agency that cares about their employees and community! Unity House is a Rensselaer County-based human service agency that provides a wide range of services to meet the otherwise unmet needs of people in our community who are hurting and struggling. We assist those who are living in poverty, adults living with mental illness or HIV/AIDS, victims of domestic violence, and children with developmental delays. We work to achieve social justice in our community and to create a better understanding of those we serve. As An Equal Opportunity Employer, we commit ourselves to recruiting, hiring, training, and promoting persons in all job classifications without regard to race, color, age, sex, creed, disability, gender identity or expression, sexual orientation, predisposing genetic characteristics national origin, domestic violence victim status, familial status, marital status, military status, pregnancy related condition, arrest and/or criminal conviction record, or any other category protected by law, unless based upon a bona fide occupational qualification or other exception.