QA Utilization Review Specialist - QAS043 - Mon-Fri 9AM-5PM Job Details Job Location Corporate Office (Main Office) - Lake Success, NY Remote Type Hybrid Education Level Graduate Degree Salary Range $26.44 - $28.85 Hourly QA Utilization Review Specialist About WellLife Network: WellLife Network is a leading health and human services organization dedicated to supporting individuals and families across New York City and Long Island. Recognized as a 2023 top-rated nonprofit, WellLife Network empowers people to overcome life’s challenges and achieve greater independence, well-being, and inclusion. We offer a comprehensive suite of programs spanning mental health, developmental disabilities, substance abuse, housing, and employment support, all grounded in a commitment to compassionate, high-quality care. Central to our mission is an unwavering dedication to diversity, equity, inclusion, and belonging (DEIB) within our organization and in the communities we serve. As a trusted community partner, WellLife Network fosters a nurturing environment where everyone has the opportunity to thrive and realize their fullest potential. Position Summary: Assess and identify appropriate resource utilization, level of care and treatment options in order to assure a plan of care is in place that will impact quality outcomes. Essential Accountabilities: + Perform admission and continued stay utilization reviews for clients served to ensure appropriate level of services are being offered. + Review individuals’ clinical documentation and health records to assess gaps in care, additional supports that may be needed, and determine if ongoing care at current level remains appropriate. + Identifies potential high risk situations involving individuals served through clinical record review. + Communicate and track any documents needed to complete Utilization Reviews. + Promote communication between QA and all care team members to enable a collaborative assessment regarding a suggested change in level of care + Effectively cultivate working relationships with care team by maintaining regular communications and professional rapport. + Perform accurate data entry of all utilization reviews and clinical determinations in compliance with all mandated due dates. + Utilize Electronic Health Record dashboards to manage a caseload of clients due for Utilization Review. + Communicate to leadership any barriers to completion of Utilization Reviews. General Requirements and Responsibilities: + Must have and maintain active NYS Licensure in behavioral health field (LCSW, LMSW, LMHC, etc.). + Communicate with all stakeholders on needed documentation and status of Utilization Reviews. + Must have basic computer skills: word processing, spreadsheets, e-mail, file creation-sharing-storage. + Attend and participate in supervisory meetings and all staff meetings, as well as other meetings/trainings as needed or directed. + Attend trainings as assigned by supervisor, within and outside of the agency. + Maintain confidentiality at all times + Meet productivity expectations and due dates as outlined by supervisor. + Work schedules and locations are subject to change. + This does not limit the assignment of duties or exclude the performance of other duties, not mentioned, as assigned by supervisor. Qualifications Required: Licensed Master of Social Work (LMSW), Licensed Clinical Social Worker (LCSW), Licensed Mental Health Counselor (LMHC), or other comparable licensed degrees (will be assessed on a case by case basis) with at least 5 years of clinical experience (2 years of clinical experience post licensure preferred); Ability to interpret clinical summaries and apply established medical necessity criteria to make utilization decisions; Excellent communication skills, both written and verbal. Preferred: Experience successfully working remotely and meeting deadlines. BENEFITS AND PERKS: At WellLife Network, we prioritize our employees' growth and well-being with a comprehensive benefits package that includes medical, vision, and dental insurance, 401(k) matching, and flexible spending accounts. Enjoy perks like Summer Fridays, gym passes, and life insurance options. Our commitment to career advancement includes tuition assistance, mentorship, leadership training, and more. As a qualifying employer for Public Service Loan Forgiveness, WellLife Network supports your career and financial goals while helping you make a meaningful community impact. Join us to experience a workplace that invests in your success and well-being!