Commission Optum Utilization Review Jobs in Rochester, NY

MISSION STATEMENT

Are you ready to give back to the community while pursuing your passion? For over 50 years, Acacia Network and its affiliates have been committed to improving the quality-of-life and wellbeing of underserved communities in New York City and beyond. We are one of the leading human services organizations in New York City and the largest Hispanic-led nonprofit in the State, serving over 150,000 individuals every year. Our programs serve individuals at every age and developmental level, from the very young through our daycare programs to mature adults through our older adults centers. Our extensive array of community-based services are fully integrated, bilingual and culturally competent.

POSITION OVERVIEW

Under the supervision of the Senior Administrator, the Program Director ensures quality care and oversees the functions of the program according to regulatory bodies and accreditation requirements. This individual is responsible for the oversight and implementation of care and resources for the purpose of meeting the physical, emotional and social needs of clients. The Program Director provides clinical supervision and oversight of all programs’ services and works to develop, implement, track, report, and evaluate measurable outcomes. The requirements listed below represent some of the knowledge, skill and or abilities required. Reasonable accommodations may be made to enable individuals with disabilities as defined by the ADA to perform essential functions of the job.

KEY ESSENTIAL FUNCTIONS

• Oversight of program services including plan, develop and monitor day-to-day operations for the residential OASAS licensed residential program.
• Oversight of the hiring process and provide leadership, guidance, direction, and supervision to all staff
• Supervise the managers of the residential program (e.g. clinical supervisor, medical director, operations supervisor, etc.)
• Participate in program evaluation activities and deliver (or learn to deliver) services using evidenced-based practices.
• Review and approval of initial needs assessment and initial treatment plans, as needed
• Knowledge of Federal, State, and City regulatory requirements and ensures that all aspects of clinical care conforms to these requirements.
• Establish and foster community/provider relationships.
• Participate in agency management and planning activities.
• Ensure client substance abuse and other therapeutic groups engaging and meets the needs of population including trips, events, etc.
• Work as clinical supervisor to provide individual and clinical group supervision to counselors and other clinical staff.
• Meet regularly with clinical supervisor to discuss and monitor program effectiveness.
• Perform utilization reviews, monitoring case records, ensuring compliance with all contract stipulations.
• Review OASAS Website keeping updated with 820 regulations and local service bulletins.
• Ensure clinical staff conduct periodic audit of client services and documentation.
• Oversee case reviews, and case conferences, as needed.
• Submit monthly and/or quarterly reports to executive management and/or performance based contractors.
• Provide crisis intervention with clients, as needed.
• Facilitate team meetings and staff development activities.
• Conduct, attend, and participate in department director’s local and national meetings, conferences, coalitions, etc.
• Interact with support services
• Administrative interaction with clinical components
• Ensure that element staff/supervisors are regularly attending
  • Team Management Meetings
  • Multi-disciplinary team meetings
  • Case conferences and utilization review meetings
• Other duties as assigned by supervisor.

REQUIREMENTS

• Master’s Degree in Sociology, Psychology or Bachelor in Human Services Field /CASAC
• A Qualified Health Professional (CASAC; LCSW; LMSW; NP; MD; PA; Psychologist; Rehabilitation Counselor; LMFT; LMHC) in good standing with the appropriate licensing or certifying authority.
• Valid and unrestricted New York State License, and/or OASAS certification as Advanced CASAC or Masters CASAC, and/or Commission of Rehabilitation Counselor Certification
• At Least five years of full-time work experience in Substance Use Disorder or related treatment field, prior to appointment as Program Director.
• Experience in management
• Proficient computer skills including using electronic health record
• Strong follow-up skills required
• Must have excellent verbal and written communication skills
• Ability to work in and be sensitive to a culturally diverse environment
• Ability to maintain a professional demeanor under pressure and operate with a keen sense of urgency and commitment to quality.
• Bi-lingual Spanish Speaking, preferred
• Must have specific training in chemical use, abuse and dependence specific to the services provided:
  • Obtain within six months of hire:
    • Supporting Recovery with Medications Addictions Treatment (MAT)
    • Clinical Supervision 1 (14 hours)
    • Clinical Supervision 11 (16 hours)
  • Obtain with thirty days of hire:
    • Screening, Brief Intervention and Referral to Treatment
    • CASAC Canon of Ethics (6 hours)
    • Confidentiality related to 42CFR (3 hours)
    • Mandated Reporter (2 hours)

WHY JOIN US?

Acacia Network provides a comprehensive and competitive benefits package to our employees. In addition to a competitive salary, our benefits include medical, dental, and vision coverage. We also offer generous paid time off, including vacation days and paid holidays, to support a healthy work-life balance. We prioritize the well-being of our employees both professionally and personally.

As an Equal Opportunity Employer, we encourage individuals from all backgrounds to apply.