What are the responsibilities and job description for the Chart Compliance & Utilization Review Specialist position at PATHWAYS YOUTH & FAMILY SERVICES INC?
Job Details
Description
Job Summary
The Chart Compliance & Utilization Review Specialist will conduct prospective, concurrent, and retrospective reviews and activities to evaluate and recommend improvements to Pathways’ programs. The Specialist will use data, information contained in case records, external feedback, and information elicited from direct contact with service providers to ensure Pathways is providing quality, effective, and efficient services at the appropriate level of care for each client served.
Essential Duties:
- Assists in the preparation, aggregation, response, and follow-up for performance and outcome review and reporting, internal and external.
- Assists in the preparation, response, and follow-up for monitoring reviews, audits, investigations, and queries, internal and external.
- Conducts compliance and utilization review activities including the coordination of the case record review process.
- Conducts follow up of case record review activities including the remediation of deficiencies, completion of action plans, collection of data, and provide consultation when needed.
- Monitors provider and program adherence to standards, rules, and regulations related to service delivery, utilization, and documentation.
- Participates in the employee, client, and stakeholder feedback and satisfaction process.
- Reviews, revises, and designs surveys, forms, and other tools.
- Collaborates closely with departmental Directors and Supervisors to review chart audit findings in order to assist in identifying trends and any areas of need.
- Participates in meetings, committees, workgroups, or agency activities as directed.
- Stays abreast of current national, state, and local laws, regulations, standards, and requirements affecting the treatment and authorization of services for Pathways’ clients.
Supervisor: Chart Compliance and Utilization Review Manager.
Supervises: N/A.
Work Hours: Full-time, working a minimum of 40 hours per week. Work hours set by the employee, with allowances for some weekend, holiday, and evening hours required. Work is remote and may require some time in office as the need arises.
Classification: Hourly.
Qualifications
Education & Experience:
- At least three years’ experience participating as a member of a service or treatment team or working in human services.
- Bachelor’s Degree in a human services or related field of study.
- Preferred competence in performing quality assurance and utilization review activities.
Knowledge, Skills & Abilities:
- Ability to support the agency's culture, growth, and success through communication, accountability, and positivity.
- Ability to be clear headed and decisive based on the scope of the position.
- Ability to work efficiently and effectively both individually and as part of a team.
- Ability to appropriately accept feedback through the supervision process-thus displaying the willingness to learn, grow, and improve.
- Detail-oriented.
- Competent in using Microsoft Word, Excel, the Internet, and other program applications.
- Effective oral/written communication and organizational skills.
- Ability to effectively work as part of a professional team.
Additional Requirements:
- Proof of valid Texas Driver’s License (Type C) and at least three years of driving experience.
- Access to reliable transportation.
- Proof of valid/current auto insurance.
- Cleared motor vehicle driving record.
- Three employment references.
- Cleared background check and signed affidavit.
- Cleared tuberculosis (TB) test results (current within 12 months prior to employment).
- Cleared drug test.
- Working cellular telephone at all times.
Physical & Mental Demands:
With or without reasonable accommodation, the physical and mental requirements of this job may include the following: seeing, hearing, speaking, and writing clearly. Occasional reaching with hands and arms, stopping, kneeling, crouching, crawling, frequent sitting, standing and walking, may be required for long periods of time and may involve climbing stairs, walking up inclines, and on uneven terrain. Additional physical requirements may include, frequent lifting and or moving up to 15 pounds.
