Clinical Review Manager

We need hope-bringers and changemakers - because the work we all do matters. Join a team that shows up for each other as much as we show up for our clients. At Gaudenzia, your purpose fuels progress - for yourself and others.

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.

Qualifications:

• Education: High School Diploma or GED

• College Degree preferred

• Experience:

• 5+ years of billing in substance use disorder or mental health industry

• Working knowledge of managed care, government funders a must, with experience in billing, utilization and review of the DC market

Your responsibilities in this role may include:

• Treat all clients and staff with dignity and respect
• Supervise audit and review process and provide documented recommendations based on appropriate guidelines
• Review and approve documentation associated with 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
• Resolve client 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 Operations Director, or designee
• Knowledge of Managed Care, including DC and Comagine preferred
• Knowledge of regulatory, licensing, and accreditation standards
• Knowledge of utilization review process
• 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 backgrounds
• 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.

What We Offer: Competitive Pay - Excellent Benefits - On The Job Training - Upward mobility - Educational assistance to help you grow with us in this life saving field!

For additional details regarding our benefits, please visit: https://www.gaudenzia.org/careers/

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.