Quality Auditor/Reviewer Clinician - Hybrid position at Seven Counties Services

Louisville, Kentucky, United States -

Full Time

Start Date

Immediate

Expiry Date

22 May, 26

Salary

0.0

Posted On

21 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Record Review, Medical Necessity Review, Compliance, Quality Improvement, Utilization Review, Data Analysis, Consultation, Education, Auditing, Training Development, Program Oversight, Evidence-Based Practices, Interpersonal Skills, Communication Skills, Attention To Detail, Planning

Industry

Mental Health Care

Description

Job Description: This is a hybrid position open only to residents of the Louisville Metro area! ESSENTIAL JOB FUNCTIONS Conducts routine reviews of clinical records for quality, medical necessity and compliance with licensure, state and federal guidelines, payer guidelines and evidence-based practices. Interacts with staff and managers to provide consultation, feedback, and ongoing education. Provides quality improvement consultation related to quality of care and utilization review. Reviews data and trends to identify and coordinate improvement activities. Partners with divisions to ensure compliance with quality and compliance initiatives and requirements. Keeps abreast of current rules, regulations, policies and procedures applicable to initiatives including documentation requirements. Conducts compliance investigations as needed and appropriate. Participates in compliance and quality audits and provides support for monitoring audits. Monitors DCO’s (Designated Collaborating Organization) through program reviews and implements, trains, and provides oversight of DCO contract deliverables, as appropriate. Develops and maintain updates of training for staff to implement process changes and improve performance. Facilitates trainings aligned to organization needs for specific training content, that may include becoming a “Train the Trainer” by external agencies to facilitate the training for our organization. Provides feedback on clinical content in health records. The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job. Incumbents may be requested to perform job-related tasks other than those specifically presented in this description. EDUCATION Master's degree in social services field, plus appropriate license from a Kentucky Board of Licensure. EXPERIENCE Three plus years’ experience including some experience in quality program review. Demonstrated competencies in clinical administration and delivery, organization and attention to detail Good planning, interpersonal and communication skills REQUIREMENTS Independent licensure in area of specialization (e.g., Licensed Clinical Social Worker, Licensed Clinical Alcohol and Drug Counselor, Licensed Professional Clinical Counselor, Marriage and Family Therapist, Professional Art Therapist) issued by Kentucky Board of Social Work or appropriate board of the Kentucky Department of Professional Licensing. PHYSICAL DEMANDS Occasional minor discomforts from continual exposure to video display terminal. COMPANY OR PERSONAL VEHICLE USAGE: No Within the bounds of their respective job descriptions, all staff are expected to exercise principle-centered leadership, focused on customer service responsiveness, with a continuous quality improvement orientation. Additionally, all staff are expected to develop a working knowledge of and follow all policies and procedures related to safety management and other Joint Commission standards. Time Type: Full time Seven Counties is the provider of choice for mental and behavior health services in and around the Louisville Metro. Over 1,400 employees work in 25+ locations throughout Bullitt, Henry, Jefferson, Oldham, Shelby, Spencer and Trimble counties; making sure that the 31,000 people we serve annually have the best chance of living their best lives. At Seven Counties, we give our staff the opportunity to do what they do best with continued training, effective mentoring and competitive salaries and benefits. In an effort to protect our employees, clients and community, we require the COVID and Influenza vaccinations for all employees.

Responsibilities

The role involves conducting routine reviews of clinical records for quality, medical necessity, and compliance with various guidelines, while also interacting with staff to provide consultation, feedback, and ongoing education. Responsibilities include reviewing data trends to coordinate improvement activities, participating in audits, and developing/maintaining staff training related to process changes.