Clinical Review Clinician - Gaudenzia

Overview:

Do You have the heart to serve others and making a lifelong impact? We need hope-bringers and changemakers — because the work we all do matters. If you’re passionate about making an impact with your time and being someone’s light in the darkness, we want you on our team. Come Join Us to Do Mission-Based, Meaningful Work

 

 

Picture Yourself at Gaudenzia as a Clinical Review Clinician at our R.A.P. Program located in Washington D.C.! We are seeking compassionate professionals who are willing to make a difference and serve as a positive role model to those suffering from substance use & co-occuring disorders. 

 

What We Offer:

 

• Full Time Opportunity with excellent pay and benefits package
• Educational assistance to help you grow with us in this life saving field!
• Compensation ranges from $32.70 to 38.45 per hour (based upon experience and licensure)
• On The Job Training

 

Who We Are

Gaudenzia is one of the largest nonprofit providers of treatment to people with substance use and co-occurring disorders in the nation. We operate in Pennsylvania, Delaware, Maryland, and Washington, D.C.  

 

Our caring, compassionate team is on a mission to save thousands of lives each year and bring hope to people devastated by substance use disorder. Together, we help individuals, families, and communities heal and thrive in the face of one of the most devastating public health crises of our time.

 

As our organization grows and evolves to meet the needs of our clients and communities, we’re seeking passionate, empathic individuals to help us make an impact. With your help, we can turn the tide on substance use disorder.    

Who we’re looking for:

 

The Clinical Review Clinician plays a pivotal role in overseeing the clinical review process for substance use disorder treatment authorizations. This position requires a blend of clinical expertise, leadership skills, and a thorough understanding of utilization management to ensure the highest standards of care and compliance with established guidelines.

We are seeking individuals who excel in leadership roles, can work independently, and are adept at managing deadlines. The ideal candidate will have extensive experience in utilization management, as well as familiarity with DC and Comagine. This role involves significant interaction with healthcare providers, internal program management, and external stakeholders to ensure the accuracy and timeliness of clinical reviews.

Key responsibilities include supervising the clinical review team, conducting thorough clinical reviews, maintaining accurate records of authorization decisions, and collaborating with other team members to achieve program goals and objectives. The Clinical Review Clinician is also responsible for staying up-to-date with the latest clinical guidelines and best practices, providing training and support to the clinical review team, and ensuring compliance with all regulatory requirements.

The work is performed with considerable independence, adhering to established regulations, policies, and procedures. The Clinical Review Clinician reports to the Utilization Management Director, who reviews and supervises the work.

 

Responsibilities:

Your responsibilities in this role may include:

• Treat all clients and staff with dignity and respect
• Manage and submit the clinical and medical documentation as required for pre-authorization and ongoing authorizations
• Supervise initial clinical reviews and provide documented recommendations based on appropriate clinical guidelines
• Review and approve initial evaluations and clinical documentation against clinical standards, applicable state regulations, insurance requirements, and relevant treatment guidelines
• Ensure accurate, up-to-date records, including intake, records of referral, and funding source documentation are compiled and stored within the electronic health record system within the required timeframes
• Assist clinical staff in quality improvement projects by providing instructive feedback within the scope of practice
• Resolve patient care issues by working one-on-one with community providers and staff to address issues in the determination process
• Establish and maintain positive relationships with funding, referral, and regulatory agencies
• Provide information by responding to queries from funding sources, sorting and distributing messages and documents, and preparing information for determinations
• Improve quality results by studying and evaluating procedures and processes, and recommending changes if needed.
• Other duties as assigned by the Clinical Director, or designee

 

Benefits & Perks:

Gaudenzia is a diverse, inclusive workplace where purpose-driven people thrive. We think our team members are real heroes, and we believe those who devote their lives to making the world a better place deserve competitive salaries, generous health benefits, and unbeatable work-life balance in return.

Benefits & Perks at Gaudenzia include:

• Medical insurance
• Dental insurance
• Vision Insurance
• Life Insurance
• Generous Paid Time Off: Sick and Vacation
  • Sick time: one hour of leave for every 37 hours worked up to a maximum of 7 days per calendar year - 4 hours per pay period (Years 1-5), 6 hours per pay period (Yrs 6-14), 8 hours per pay period (Yrs 15+) -maximum 200 hours
  • Vacation time:  4 hours per pay period (Years 1-5), 6 hours per pay period (Yrs 6-14), 8 hours per pay period (Yrs 15+) - maximum 200 hours
• 10 Paid Holidays Per Calendar Year
• Paid Bereavement Leave
• Education Assistance Benefit (Tuition Reimbursement)
• Full reimbursement for the cost of professional license/certification renewals
• Employee Assistance Program

Gaudenzia is an equal opportunity employer. We do not practice or permit discrimination based on race, gender, gender identity, gender expression, sexual orientation, age, national origin, religion, creed, disability, or veteran’s status.

Qualifications:

Qualifications for this role:

 

Education/ Training:  Must hold a master’s degree in social work, counseling, psychology, or a related field with active DC independent clinical licensure (e.g. LICSW, LPC, LMFT, or licensed psychologist)

 

Experience: 3+ years of clinical practice in substance use. 1+ years of utilization review and/or utilization management or quality assurance.

 

• Knowledge of Managed Care, including DC and Comagine preferred
• Knowledge of clinical practices, regulatory, licensing, and accreditation standards
• Knowledge of utilization review process
• Knowledge and ability to work with electronic health record systems
• Knowledge of substance use and mental health disorder treatment programs
• Knowledge of quality improvement processes, including the ability to evaluate and recommend changes to enhance service quality
• Ability to communicate effectively, both verbally and in writing
• Ability to successfully work with others from various cultures and backgrounds
• Ability to plan and organize work and prepare appropriate, accurate records, and reports
• Ability to establish and maintain effective working relationships with clients, staff, health care providers, referral entities, outside agencies, institutions and the general public

 

 

What Matters to Us? Our Mission & Our Operating Principles

 

Our Mission 
Gaudenzia aspires to connect individuals and families to addiction and mental health treatment so they can attain long-term recovery and achieve a fulfilling life embraced by a broad community of mutual support. 

 

Our Operating Principles:

We, as members of the Gaudenzia Team, are committed to these principles. They guide the way we perform Gaudenzia business, every day.

1. We hold client care as our top priority.
2. We assume good intentions.
3. We are present, we connect, and we communicate with transparency, dignity, and respect.
4. We make data-driven decisions with courage, challenge the status quo, and find innovative ways to grow Gaudenzia and each other.
5. We support each other publicly and privately in all circumstances.
6. We provide and accept constructive, honest, respectful, and timely feedback with an open mind and without personalization.
7. We operate with integrity, focus on outcomes, and have a bias for action.
8. We follow through on agreements and honor commitments prioritized with a sense of urgency — someone’s life may depend on it.

Gaudenzia is proud to be an employer of choice — and a treatment provider of choice — in the substance use and co-occurring disorders treatment field. We work hard to foster an inclusive, supportive environment where our employees and clients always feel safe and welcome. Come work with us!