Clinical Review Clinician

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-occurring 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.

 

 

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 proce