Initial Clinical Reviewer Jobs (NOW HIRING)

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 master's level, licensed, clinician, with documented experience in utilization review, management, and quality assurance skills! Are you ready and willing to make a difference and serve as a positive role model to those suffering from substance use & co-occurring disorders.
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 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.
Salary: $75-87K annually
Requirements:

• 3+ years of clinical practice in SUD
• 1+ years of utilization review, utilization management, and quality assurance

Education/ Training:

• Must hold a master's degree in social work, counseling, psychology, or a related field
• Must possess an active DC independent clinical licensure (e.g. LICSW, LPC, LMFT, or licensed psychologist)

Scheduling:

• Onsite Position
• Must work 11-7 or 12-8 (4 days during the week)
• Must work either Sat or Sun 8 hour day (can be early 8am thru 4pm, however there is flexibility)

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!
• 100% Reimbursement for License renewals

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

Knowledge, Skills, & Abilities:

• 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 background
• 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

Gaudenzia's Mission: Gaudenzia's Mission is to promote long-term recovery by providing comprehensive treatment and support to people with substance use disorder, co-occurring mental health disorders, and related conditions, regardless of individual circumstances.
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!
Our Agency is committed to the principles of equal employment. We believe in fostering a positive work environment in which every employee is treated with respect. Our staff hiring and recruitment practices are grounded in fairness, transparency, and merit. All employment decisions are based on job-related qualifications, relevant skills, experience, and alignment with our mission and values. We actively recruit from a broad range of educational and professional backgrounds to attract the most qualified candidates, ensuring equal opportunity for all applicants without preference or discrimination. Our process uses consistent and clear evaluation criteria to support objective decision-making. By emphasizing accountability, efficiency, and integrity throughout every stage--from job posting to onboarding--we build a workforce defined by excellence, professionalism, and commitment to our shared purpose. Gaudenzia is dedicated to the fulfillment of this policy regarding all aspects of employment, including but not limited to recruiting, hiring, placement, transfer, training, promotion, rates of pay, and other compensation, termination, and all other terms, conditions, and privileges of employment.