Utilization Review Specialist Jobs in Decatur, GA

Description Pay Grade: L The Georgia Department of Community Health (DCH) is one of Georgia's four health agencies serving the state's growing population of over 10 million people. DCH serves as the lead agency for Medicaid, oversees the State Health Benefit Plan (SHBP) and Healthcare Facility Regulation, impacting one in four Georgians. Through effective planning, purchasing and oversight, DCH provides access to affordable, quality health care to millions of Georgians, including some of the state's most vulnerable and under-served populations.

Six enterprise offices support the work of the agency's three program divisions. DCH employees are based in Atlanta, Cordele and across the state. DCH is committed to providing superior Customer Service and Communication, embracing Teamwork and fostering Accountability to ensure that our internal and external customers and stakeholders feel included, respected, engaged and secure.

DCH is currently seeking qualified applicants for the position of Compliance Specialist 2, Long-term Care Unit with Healthcare Facility Regulation Division. This position will document and conduct on-site surveys and require regional travel. Regional travel may require up to 90% overnight travel.

Occasional weekend and after-hours work may also be required. This is a home based position located in the (Southern Region). Note: All applicants must reside in one of the Zone 10 following counties: Baker, Brooks, Calhoun, Clay, Colquitt, Crisp, Decatur, Dooly, Dougherty, Early, Grady, Lee, Miller, Mitchell, Quitman, Randolph, Seminole, Stewart, Sumter, Terrell, Thomas, Webster, Worth.

Job Responsibilities Under general supervision, may plan, organize or coordinate the activities of an assigned program. Reviews, monitors and ensures compliance with assigned program area's policies and procedures. Conducts on-site reviews, audits or surveys of clinical and treatment facilities, regulated entity operations and program management.

Conducts utilization reviews, peer reviews, evaluation activities and all other reviews on a scheduled basis. Coordinates investigations involving noncompliance in facilities, community programs, regulated entity operations and other related programs. Coordinates the data management and quality assurance functions.

Determines compliance with applicable state and/or federal rules and regulations. Develops, implements and evaluates the surveillance of utilization review process to ensure quality services. Monitors, tracks, and maintain records on compliance.

Plans and evaluates outcome studies and/or compliance findings. Plans, develops, schedules and implements surveys and complaint investigations for licensure or certification of regulated facilities. Plans, organizes, and directs the certification/licensing process.

Recommends programmatic and/or operational changes based on review, audit or survey results. Reviews new rules and service site applications. Researches and analyzes state codes, federal regulations and industry manuals regarding forms, policies and procedures.

Reviews applications for accuracy and compliance with guidelines, regulations and laws. Performs investigations and/or audits according to established rules, regulations and other statutes. Minimum Qualifications Master's degree in a related field from an accredited college or university OR Bachelor's degree in a related field from an accredited college or university AND Two years of related experience OR Associate's degree in a related field from an accredited college or university AND Three years of related experience OR Four years of related professional experience.

Note: Some positions may require a certification or licensure. Note: Possession of a valid Georgia driver's license, which would enable the applicant to drive in Georgia, and use of a car at work, are required for employees in this job. PREFERRED QUALIFICATIONS: Preference will be given to candidates, who have a healthcare background and in addition to meeting the qualifications listed above, possess the following: Certification(s) and/or Degree in one or more of the related fields Experience in the field of home health and/or hospice or hospital, assisted living, private homecare, adult daycare or any licensed healthcare facility Experience as as a Registered Nurse/LPN, or licensed professional in a healthcare setting.

Experience as a Registered Nurse/LPN in the field of mental health or Drug Treatment. Experience in utilization review and/or quality assurance in a healthcare setting. Experience in conducting assessments and evaluations based on regulations, legal requirements and/or recognized accreditation standards.

Demonstrated ability to produce high quality documentation with attention to detail. Strong communication and writing skills. Strong organizational and time management skills.

Additional Information EARN MORE THAN A SALARY. In addition to a competitive salary, the Georgia Department of Community Health offers a generous benefits package, which includes employee retirement plan; paid holidays annually; vacation and sick leave; health, dental, vision, legal, disability, accidental death and dismemberment, health and child care spending account. Due to the volume of applications received, we are unable to provide information on application status by phone or e-mail.

All qualified applicants will be considered, but may not necessarily receive an interview. Selected applicants will be contacted by the hiring agency for next steps in the selection process. Applicants who are not selected will not receive notification.

THIS POSITION IS SUBJECT TO CLOSE AT ANY TIME ONCE A SATISFACTORY APPLICANT POOL HAS BEEN IDENTIFIED. APPLICATIONS WITHOUT WORK EXPERIENCE LISTED WILL NOT BE CONSIDERED. CURRENT GEORGIA STATE GOVERNMENT EMPLOYEES WILL BE SUBJECT TO STATE PERSONNEL BOARD (SPB) RULE PROVISIONS.

THE POSITION MAY BE FILLED AT A LOWER OR HIGHER POSITION LEVEL. This position is unclassified and employment is at-will. Candidates for this position are subject to a pre-employment background history and reference check.

For more information about this job and other career opportunities with DCH, please visit our Careers Page: https://www.governmentjobs.com/careers/dchga.