Dominion Professional Associates is looking for consultants who can fill up our open positions with the right qualifications and sense of dedication. We are offering competitive wages as well as a working environment that fosters unity and camaraderie. To send an application, please use our online form.
Remote Clinical Reviewer/Consultants:
Summary: Dominion Professional Associates
- Is seeking individuals to review and audit medical records of individuals who are receiving healthcare services (Behavioral Health) in the State of Georgia.
Essential Job Functions:
- Review case records, as well as consumer records to secure right utilization of treatment process for the right case documentation, and medical necessity of treatment related to state, federal, and county regulations.
- Assess continuing Treatment Plans by reviewing records to make sure that the consumer receives proper and necessary treatment, and request authorizations.- Review consumer admission data, clinical documentation, ensure compliance for case documentation and medical necessity.
- Go over records to assess proper treatment, aftercare, and discharge planning.
- Provide information and training about utilization requirements to supervisory, clinical, and management staff in quality improvement and utilization meetings and projects.
- Partake in audits of programs to secure agency compliance on utilization review regulations.
- Experience with the Audit Utilization Review process, and possess knowledge with the State of Georgia’s DBHDD Provider Manual as it pertains to CORE/IFI Services.
- Masters Degree in the Behavioral Health or Social Services Field that is primarily psychological/clinical in nature or at least 5 years experience with a Bachelor Degree. Licensed Counselors or RN’s ( with Psy experience) is preferred.
- 2 years directly related professional experience with DBHADD Policies and Procedures.
- Knowledge with Medicaid and CMO billing codes, policies and procedures.
- Knowledge and Experience in understanding of the DBHADD/CMO Healthcare Policies and Regulations as it pertains to CORE Services.
OTHER JOB FUNCTIONS
- Work in close collaboration with other team members to support the development of new projects and the continuous improvement of the overall work of the team.
- Promote core values of teamwork, professionalism, effective communication skills and a positive attitude.
- Maintain security and confidentiality of all information in accordance with HIPAA laws, regulations, and company policies.
- Demonstrate compliance with corporate and departmental policies as evidenced by attendance, punctuality, and professional appearance.
- Performs other duties as assigned.
KNOWLEDGE, SKILLS, AND ABILITIES
- Knowledge of ICD-10-CM and DCH program regulations governing GAPP Policies and Procedures preferred
- Strong theoretical clinical knowledge based and problem-solving skills
- Strong organizational skills with the ability to demonstrate work priorities
- Demonstrated ability to perform work with considerable independence by use of creative thinking through analysis of problems, and use of innovative approaches to problem resolution
- Understand Georgia DBHDD/ASO policies and procedures or other States (see website)
- Computer knowledge, including typing skills at 30-50 WMP and data entry skills
- Excellent interpersonal, written, and verbal skills required