Clinical Compliance & Utilization Review Spec

Unity House Of Troy is hiring a Clinical Compliance – Utilization Review Specialist in Sycaway, Rensselaer County, NY. The role ensures medical necessity and compliance for New York State Office of Mental Health‑licensed programs.

Key Responsibilities

• Perform utilization reviews for OMH‑licensed services such as ACT, MHOTRS, PROS, Crisis Residence, and other programs.
• Verify that all services are medically necessary, properly authorized, and documented according to state regulations.
• Collaborate with clinicians, administrators, and payers to resolve authorization issues and ensure timely service delivery.
• Maintain accurate records, prepare audit reports, and support internal and external compliance audits.
• Stay current with NYS OMH policies, Medicaid guidelines, and federal regulations affecting behavioral health services.

Qualifications & Requirements

• Bachelor’s degree in Health Administration, Nursing, Public Health, or related field (Master’s preferred).
• Minimum 2‑3 years of experience in utilization review, clinical compliance, or health services auditing, preferably in mental health settings.
• Strong knowledge of NYS Office of Mental Health programs and Medicaid billing requirements.
• Excellent analytical, written, and verbal communication skills.
• Proficiency with electronic health record (EHR) systems and Microsoft Office suite.

Compensation & Benefits

Salary range: $66,770 – $69,565 annually, commensurate with experience. Unity House Of Troy offers a comprehensive benefits package including health insurance, retirement plan, paid time off, and professional development opportunities.

How to Apply

Submit your resume and a cover letter outlining your relevant experience to the Unity House Of Troy HR portal. Applications will be reviewed on a rolling basis.

Frequently Asked Questions

What types of programs will I review in this role?

You will conduct utilization reviews for OMH‑licensed services including Assertive Community Treatment (ACT), Mental Health Outpatient Treatment and Rehabilitation Services (MHOTRS), Personalized Recovery Oriented Services (PROS), Crisis Residence programs, and other state‑approved mental health programs.

What qualifications are required for the Clinical Compliance Specialist position?

A bachelor’s degree in health administration, nursing, public health or a related field is required, with 2‑3 years of utilization review or clinical compliance experience, preferably in mental health, and knowledge of NYS OMH and Medicaid regulations.

What is the salary range for this position?

The annual salary ranges from $66,770 to $69,565, depending on experience and qualifications.