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About the Role

The Clinical Audit Specialist conducts objective, clinically rigorous chart reviews to ensure compliance with regulatory standards, accuracy of clinical information, and adherence to organizational policies. This role supports quality improvement initiatives and helps maintain high standards of individual care, functioning as an independent clinical quality assurance resource.

Responsibilities

• Coordinates with Director of Quality Assurance and Compliance annual schedule of clinical audits.
• Conduct routine, focused and follow up clinical chart audits using standardized tools to ensure completeness, accuracy, and compliance with state, federal and organizational guidelines.
• Identify documentation gaps, inconsistencies, or errors and communicates findings to clinical staff for correction.
• Reviews documentation across assessment, treatment planning, progress notes, group documentation and discharge planning.
• Apply consistent scoring aligned with established standards and interpretation guides.
• Ensures charts meet requirements of HIPAA, Joint Commission and other applicable regulations.
• Identifies documentation strengths and improvement opportunities and collaborates with supervisors and clinicians to support remediation.
• Develops and supports strength based Corrective Action Plans when indicated.
• Supports peer reviewers and supervisors in understanding audit standards.
• Prepares summaries and reports of audit findings for management and quality improvement committees.
• Link audit findings to appropriate training and Continual Quality Improvement initiatives.
• Contributes to identification of system-level trends and documentation gaps.
• Assists in developing educational material related to documentation, compliance or procedures.
• Investigates and monitors issues of non-compliance and coordinates with the program to implement appropriate internal controls.
• Recommends future course of action based on audits and data analysis.
• Conducts training and provides updates regarding internal controls and regulatory compliance.
• Adheres to all applicable federal and state laws, as well as CCFCS internal policies, including but not limited to those governing client confidentiality, privacy, program standards and billing and documentation standards.
• Maintains high level of expertise in specialized areas through continuing education, individual contacts, and attendance at appropriate meetings.
• Attend mandatory training.
• Actively pursues development of professional competencies related to job performance through reading, supervision, in-service training and attendance at conferences and workshops.
• Attend staff meetings and other agency committee meetings as appropriate to duties and responsibilities and communicate information directly to appropriate staff.
• Represent Catholic Charities Family and Community Services on appropriate committees.
• Awareness and active support of the Agency's Mission, Vision, Values and Strategic Plan.
• Other duties as assigned.

Requirements

• Master’s Degree in Social Work, Mental Health Counseling, Psychology, Nursing or related field.
• Equivalent combination of education and experience will be considered.
• Licensed Master Social Worker (LMSW) preferred.
• 2+ years of behavioral health clinical experience.
• Familiarity with electronic health record (EHR) systems.
• Preferred experience in quality assurance, utilization review or clinical auditing.
• Experience with Trauma-Informed care and integrated behavioral health models.
• Familiarity with NYS OMH including HCBS and OASAS regulations and Medicaid Managed Care requirements.
• Familiarity with OMIG audit processes and Medicaid documentation.
• Employee is frequently required to sit, talk, hear, stand, walk, use hands to type and/or perform light lifting.
• Specific vision abilities required by this job include close vision, distance vision and ability to adjust focus.
• Adheres to all applicable federal and state laws and regulations including, but not limited to, those governing confidentiality, privacy, program, billing and documentation standards.
• All duties must be performed in accordance with CCFCS’s corporate compliance & ethics program.
• Any offer of employment will be contingent upon successful completion of a background check.

Skills

• Quality Assurance
• Utilization Review
• Clinical Auditing
• Trauma-Informed Care
• Integrated Behavioral Health Models
• NYS OMH
• HCBS
• OASAS regulations
• Medicaid Managed Care
• OMIG audit processes
• Medicaid documentation
• HIPAA
• Joint Commission
• Corrective Action Plans
• Training
• Documentation
• Compliance
• Data Analysis

Location

• Remote

Work Type

• Full-Time
• Onsite

Experience Level

• 2+ years of behavioral health clinical experience

Education Level

• Master’s Degree in Social Work, Mental Health Counseling, Psychology, Nursing or related field.

Salary/Compensations

• $65,000 - $70,000

Benefits

• Competitive salary and 403b retirement plan
• Generous time off package and work-life balance
• Comprehensive benefits package
• Supportive and collaborative environment
• Opportunities for growth and development
• Intrinsic reward of truly making a difference in people's lives

About the Company

• Catholic Charities Family and Community Services (CCFCS) has been serving our community for over 100 years.
• We walk with people when they are at their most vulnerable as they journey toward independence to reach their full human potential.
• We proudly serve and employ people from all backgrounds and experiences.
• If you're looking for more than just a job, if you're passionate about making a meaningful impact on the lives of others, join a team that changes lives every day.
• Be a part of something truly special.

Equal Opportunity

• Catholic Charities is committed to leveraging the talent of a diverse workforce to create great opportunities for our agency and our people. EOE/AA Disability/Vet