Authorization Utilization Review Jobs in Virginia

Position Summary

The Clinical Supervisor (CS) provides oversight, leadership, and direction to the clinical staff of Tandem Behavioral Health. This role ensures compliance with all federal, state, and local regulations, promotes excellence in clinical care, and maintains adherence to Virginia Medicaid and DBHDS standards. The Clinical Supervisor develops, as needed, and implements policies and procedures, supervises clinical staff, oversees investigations and risk management, and ensures high-quality care and documentation. The Clinical Supervisor provides direct Clinical supervision to counselors, Peers, Case Managers/Discharge Planners, Assessment Specialist, Utilization Review Specialist,  and other staff only in the absence of the Clinic Director. 

Key Duties & Responsibilities

Referral & Intake Coordination

• Conduct screenings, admissions, referrals, and assessments, as needed
• Oversee client intake and orientation processes, as needed.

Authorizations

• Complete and/or oversee the completion of Continued Stay requests, as clinically appropriate
• Complete and/or oversee the completion of Initial Authorization requests for initiation of services
• Follow up on the status of authorization requests, as needed
• Provide oversight to Utilization Review Specialist Workflow
• Input authorization approvals into the HER, as needed
• Follow up on discrepancies with authorization requests
• Participate in Peer-to-Peer Reviews

Documentation & Records

• Review and approve medical records requests.
• Ensure timely processing of medical records requests.
• Ensure timely completion of discharge summaries, as needed.
• Write annual and quarterly reports.
• Approve and monitor Client Service Plans.
• Develop and update Individualized Service Plans (ISPs).
• Ensure that documents have appropriate signatures.
• Complete chart audits for compliance.
• Submit and/or approve all clinical documentation, including progress notes, treatment plans, quarterly reports, and assessments, within 24 hours, in compliance with
• Virginia Medicaid guidelines.
• Maintain accuracy and confidentiality of client records.

Program & Client Support

• Perform shift work during staffing shortages, including case management, administrative, and group coverage.
• Participate in monthly on-call rotation.
• Participate in drug screen coverage rotation.
• Promote Tandem Behavioral Health at conferences, provider fairs, and community events.
• Attend and lead required meetings, including staff meetings, house meetings, in-services, and conduct monthly client meetings.
• Assist the Clinic Director with business development initiatives, as needed.
• Initiate client de-escalation and behavior modification plans, as needed.
• Assist with group and housing assignments and updating tracker
• Provides clinical oversight for Roanoke and Bedford Locations

Operations & Compliance

• Ensure compliance with Medicaid, DBHDS, and internal policies.
• Follow procedures for grievances/complaints and abuse/neglect/exploitation reporting.
• Maintain organized digital records and contribute to risk management documentation.
• Initiate, conduct, assign, and follow up on all investigations of client abuse, neglect, and/or exploitation.
• Provide direct supervision to Counselors, Peers, Assessment Specialists, Utilization Review Specialistand Case Managers/Discharge Planners, including schedule coverage, training, and performance oversight.
• Conduct pre-service and in-service staff training, as needed.
• Track, monitor, and approve time off requests and timecards for direct reports.
• Assist with audit and accreditation visits as needed
• Monitor equipment and supplies
• Assist with daily facility walk-throughs/inspections

Qualifications

• Master’s degree in social work, Counseling, Psychology, or related field required; license or license-eligible (LCSW, LPC, LMFT, etc.) preferred.
• Minimum 2–3 years of experience in behavioral health or substance use disorder treatment.
• Knowledge of Virginia Medicaid guidelines, DBHDS regulations, and clinical documentation standards.
• Supervisory or team lead experience strongly preferred.
• Certifications required: CPR, First Aid, and Behavior Modification.
• Valid Virginia driver’s license with current DMV driving record.

Skills & Competencies

• Strong organizational and time-management skills with ability to multitask.
• Strong clinical assessment, treatment planning, and documentation skills.
• Ability to supervise, coach, and motivate staff effectively.
• Excellent organizational, time-management, and problem-solving abilities.
• Strong interpersonal and communication skills, both verbal and written.
• Ability to manage confidential information with discretion.
• Excellent verbal and written communication skills.
• Attention to detail and accuracy in documentation.
• Proficiency in Microsoft Office Suite, Google Workspace, and fax/email systems.
• Ability to work collaboratively with clinical, administrative, and leadership staff.
• Able to de-escalate stressful situations.

Reporting Structure

• Reports to: Clinic Director of Operations
• Clinical Supervision to: Peers, Counselors, Case Managers/Discharge Planners, Assessment Specialist, Utilization Review Specialists
• Collaborates with: HR/Marketing, Other Site Leaders 

Physical Demands and Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or finger, handle, or feel objects, tools,
or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision, and the ability to adjust focus. The noise level in the work environment is usually moderate.

Note

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other
job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship.