Claratel Behavioral Health is an innovative, community-based behavioral health and developmental disabilities services organization located in Atlanta, Georgia. We offer a full range of mental health services, developmental disabilities programs, and substance use disorder services to underserved individuals serving over 10,000 clients annually. As a public, not-for-profit organization, the Claratel Behavioral Health operates more than 20 locations in DeKalb County with an annual budget of $31M and a diverse workforce of 500+ direct-care and support staff. Our staff of physicians, nurses, clinicians and support personnel is dedicated to helping our clients and their families recover from these debilitating disabilities and resume productive lives. We strive to provide the highest quality, evidence-based services in the least restrictive settings and we envision a community in which disabilities no longer limit potential. Claratel Behavioral Health is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF).

Industry: Mental Health Care
Company Size: 501-1,000 employees

Claratel Behavioral Health

Savvy Admin PROD

**About Claratel Behavioral Health**

Claratel Behavioral Health is an innovative, community-based behavioral health and developmental disabilities services organization offering a full range of mental health, developmental disabilities, and substance use disorder services to underserved individuals. As a public, not-for-profit organization, Claratel Behavioral Health operates in more than 20 locations in DeKalb County, Georgia, with a diverse workforce of more than 400 direct-care and support staff.

If you are passionate about driving change in behavioral health and developmental services and are eager to work in an environment that values innovation and inclusivity, Claratel Behavioral Health is the place for you. Here, your work is impactful, your growth is prioritized, and your well-being is supported. Together, we can forge pathways to a healthier future for all.

**Utilization Management Manager**

**Location: **Claratel Winn Way- 445 Winn Way, Decatur, GA 30030

**Hours: ** Monday – Friday 8:00am- 5:00pm (Hybrid)

Claratel Behavioral Health is seeking a dedicated and experienced Utilization Management Manager to oversee the UM functions and ensure appropriate authorization for behavioral health services across the agency. This role oversees the day-to-day functions of operations of utilization review including initial authorizations, concurrent reviews, reauthorizations, and appeals management. The UM Manager collaborates cross-functionally with clinical, billing, compliance, and digital strategies to optimize authorization workflows and ensure quality, coordinated care.

**Key Responsibilities**

- Supervise staff to coordinate/manage authorization process for Medicaid, CMOs, and State payers.

- Track authorization pends and provides feedback to clinical staff and supervisors regarding utilization trends.

- Assist with denials and provide assistance to clinical staff and supervisors regarding the appeal process and utilization expectations.

- Provide training to clinical staff to improve authorization documentation

- Assist with the development of technical plans which would enable the agency to prepare for possible changes in managed care.

- Provide technical assistance and advice in developing, implementing, and improving clinical programs.

- Customer Support: Responding to phone calls and emails from Clinical Staff

- System Error Coordination: Analyze and problem solve issues with current and planned systems as they relate to the integration and management of client data

- Service Corrections

- Duplicate Client records in EHR

- Documentation Errors

- Implement State Reporting Changes related to authorization in the EHR system

- Reports Prepared and Distributed to the appropriate staff

- AD Hoc Reporting

- EHR system automated reporting

**Skills And Competencies**

- Experience with healthcare information systems and software

- Proficiency in data analysis and report generation

- Excellent analytical and problem-solving skills, with the ability to interpret complex healthcare data and identify trends and patterns.

- Exceptional communication and interpersonal skills, with the ability to liaise effectively with diverse stakeholders, including medical staff, insurance providers, and regulatory agencies.

- Proficient computer skills, including experience with electronic health record systems and Microsoft products.

- Demonstrated leadership abilities, with the capacity to motivate and inspire a team towards achieving organizational goals.

- Strong attention to detail and ability to adhere to strict confidentiality guidelines.

- Demonstrated ability to work independently and manage multiple priorities in a fast-paced environment.

**Preferred Experience**

- 3-5 years of utilization management experience in a healthcare setting, with at least 2 years in behavioral health

- 2+ years of experience in a supervisory or management role

- Preferred but not required: Licensed Professional Counselor (LPC) or equivalent with at least 2 years of clinical experience.

~~Pre-employment drug screening and successful completion of a criminal history background check is required.~~

~~Claratel Behavioral Health participates in E-Verify (Company ID: 226305)~~

**Claratel Behavioral Health is an Equal Opportunity Employer. Candidates who may require an accommodation under the Americans with Disabilities Act or similar law to perform the essential functions of this job are encouraged to contact Human Resources at hrhelp@claratel.org. **

Utilization Manager - 130702

**About Claratel Behavioral Health**

Claratel Behavioral Health is an innovative, community-based behavioral health and developmental disabilities services organization offering a full range of mental health, developmental disabilities, and substance use disorder services to underserved individuals. As a public, not-for-profit organization, Claratel Behavioral Health operates in more than 20 locations in DeKalb County, Georgia, with a diverse workforce of more than 400 direct-care and support staff.

If you are passionate about driving change in behavioral health and developmental services and are eager to work in an environment that values innovation and inclusivity, Claratel Behavioral Health is the place for you. Here, your work is impactful, your growth is prioritized, and your well-being is supported. Together, we can forge pathways to a healthier future for all.

**QUALITY IMPROVEMENT SPECALIST**

The Quality Improvement Specialist is an essential member of the Quality Improvement team, which oversees and operationalizes the agency-wide Quality Improvement (QI) Plan at DeKalb CSB dba Claratel Behavioral Health.

Consistent with the agency’s commitment to improving client care through ongoing and systematic review of clinical services and business practices, the QI Specialist ensures that quality improvement efforts are person-centered, data-driven, systems-focused, and results-oriented.

The QI Specialist ensures implementation of Continuous Quality Improvement (CQI) processes, promotes engagement across all levels of the organization, and facilitates integration of quality assurance measures and performance indicators into daily operations. This position ensures alignment with regulatory and accreditation requirements, including those established by the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD), CARF International, NADD, and other governing authorities.

**Duties And Responsibilities**

- Drive continuous quality improvement (CQI) by coaching staff and stakeholders on effective QI methods, tools, and best practices to enhance service delivery and program outcomes.

- Monitor and measure performance through data collection, analysis, and reporting, providing actionable insights to leadership and program teams.

- Align programs with service standards by reviewing guidelines and collaborating with staff to optimize workflows and maintain fidelity to service intent.

- Ensure service excellence by conducting regular Quality Service Visits, facilitating internal audits, and preparing for external reviews/surveys.

- Elevate stakeholder engagement through structured satisfaction surveys, feedback loops, and targeted improvements based on data trends.

- Identify and address areas for improvement by initiating internal quality improvement plans, leading cross-functional workgroups, and facilitating problem-solving sessions.

- Strengthen compliance by drafting and submitting corrective action plans in response to audits, reviews, or investigations.

- Champion accreditation and certification readiness through preparation, coordination, and follow-up on quality-focused reviews and fidelity monitoring.

- Shape organizational policy by partnering with committees to develop, refine, and update policies and procedures.

- Engages in ongoing professional development and maintain role-specific certifications

- Advance the agency mission by supporting strategic initiatives and contributing to special projects that enhance organizational impact.

**PERFORMANCE METRICS**

- 90% or greater or exemplary fidelity on quality reviews for assigned programs

- 80% or greater on annual state-required key performance metrics

**Minimum Qualifications**

- Bachelor’s Degree in Business Administration, Non- Profit Management, Public Administration, Psychology, or related field

- Three to Five years in a similar role in a human services or behavioral health organization

**Preferred Qualifications**

- Master’s Degree in Business Administration, Non- Profit Management, Public Administration, Counseling, Psychology, or related field

- Five or more years in a similar role in a human services or behavioral health organization

- Knowledge of the community behavioral health system, service guidelines, and regulations

**Essential Skills**

- Analytical Skills: The ability to effectively analyze data and identify trends and patterns is crucial for recognizing areas that need improvement.

- Communication Skills: Strong written and verbal communication skills are necessary to effectively convey complex data and information to various audiences, including management and clinical teams.

- Collaboration and Teamwork: The QI Specialist often works with cross-functional teams, requiring strong interpersonal and teamwork skills.

- Project Management Skills: The role may involve managing multiple competing objectives and projects simultaneously, requiring strong project management abilities.

- Data Analysis Proficiency: Experience with data analysis software and proficiency in Microsoft Office Suite (especially Excel) is essential.

**Working Conditions**

The job is routinely 8:15 a.m. to 5:00 p.m. in an office setting; Some non-traditional hours may be required occasionally to support agency’s goals. Travel to varies sites for quality reviews, training, and technical assistance. This position may be eligible for consideration for a hybrid work arrangement under the telework policy.

**Needed Attributes**

- Proficient with using technology

- Detailed oriented

- Strong communicator (written and verbal)

- Mission Driven

- Critical thinker and result oriented

- Team player

- Flexible & adaptable

Pre-employment drug screening may be required. Selected applicant will be subject of an FBI Criminal History Record Check, and the applicant has the right to challenge the contents of their Criminal History Record Information, should they choose to do so. This employer participates in E-Verify.

**For more information visit ****www.dekcsb.org/careers**

**DeKalb CSB dba Claratel Behavioral Health is an equal opportunity employer regarding disability under VEVRRA and ADA**

~~Pre-employment drug screening and successful completion of a criminal history background check is required.~~

~~Claratel Behavioral Health participates in E-Verify (Company ID: 226305)~~

**Claratel Behavioral Health is an Equal Opportunity Employer. Candidates who may require an accommodation under the Americans with Disabilities Act or similar law to perform the essential functions of this job are encouraged to contact Human Resources at hrhelp@claratel.org. **

Quality Improvement Specialist

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