Utilization Review/Continuous Quality Improvement Specialist
Frederick County Local GovernmentDescription
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We are seeking a detail-oriented and clinically driven UR/CQI Specialist to support quality assurance and continuous improvement efforts for Children’s Services Act (CSA) programs. This role is responsible for reviewing high-risk and complex cases and ensuring that services are effective, family-centered, and compliant with CSA requirements and local policies. The ideal candidate will bring strong analytical skills, clinical expertise, and a commitment to improving outcomes for youth and families through collaboration, provider oversight, and data-informed recommendations.
What You'll Do:
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ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Conduct utilization reviews for CSA-funded youth and family cases, including congregate care placements, high-utilization services, and other high-risk or clinically complex cases.
- Review assessments, CANS, IFSPs, treatment plans, progress reports, and related documentation to ensure services are clinically appropriate, effective, and least restrictive and aligned with identified needs and CSA expectations.
- Assess whether services are clinically appropriate, least restrictive, fiscally responsible, and responsive to the youth and family’s documented needs, strengths, functioning, and treatment goals.
- Conduct interviews and gather information from youth, families, caregivers, case managers, service providers, and partner agencies to support utilization review and continuous quality improvement efforts.
- Prepare written UR/CQI findings, summaries, and recommendations, and provide professional guidance to FAPT, IFT, and other multidisciplinary teams regarding level of care, treatment progress, discharge planning, service alternatives, and service gaps.
- Monitor provider compliance with contractual expectations, treatment planning requirements, monthly reporting standards, incident reporting, licensing concerns, and overall quality-of-care expectations through chart reviews, provider meetings, and site visits.
- Track service utilization patterns, treatment outcomes, provider performance concerns, and systemic barriers to support continuous quality improvement initiatives, outcome monitoring, and programmatic enhancements.
- Provide consultation and technical assistance related to CANS-informed service planning, evidence-based interventions, progress monitoring, discharge planning, audits, policy implementation, training activities, and confidentiality compliance.
- Maintains confidential records and communications in accordance with CSA requirements, local policies, HIPAA/FERPA, where applicable, and other confidentiality requirements.
- Performs other duties as assigned.
What We're Looking For:
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EDUCATION: Master’s Degree in Social Work, Counseling, Psychology, Marriage and Family Therapy, Human Services, or a closely related field required.
CERTIFICATES, LICENSES AND/OR REGISTRATIONS: Clinical license or license-eligible status in Virginia preferred. Must be proficient in the CANS and become certified as a CANS SuperUser within 30 days of employment or within the timeframe approved by the CSA Coordinator. Must possess a valid driver’s license.EXPERIENCE: Minimum one year of experience in behavioral health, child welfare, juvenile justice, special education, or children’s services required. Experience with utilization review, treatment planning, residential care, Medicaid behavioral health services, CSA, CANS, or provider quality assurance preferred. Related internship experience may be considered.
OTHER KNOWLEDGE, SKILLS AND ABILITIES: Requires strong clinical assessment, documentation review, analytical, written, and verbal communication skills. Ability to interpret and apply complex policies, contracts, and treatment documentation while exercising sound clinical judgment in time-sensitive situations. Must collaborate effectively with families, providers, and partner agencies, manage conflict professionally, and work independently under strict deadlines. Proficiency with Microsoft 365 and standard office technology required. Knowledge of CSA, CANS, Medicaid behavioral health services, evidence-based practices, and licensing standards preferred.
Supplemental Information
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PHYSICAL DEMANDS: Requires regular physical activity, including walking, standing, sitting, writing, typing, bending, and operating office equipment. Work involves preparing and analyzing data and observing community and service settings. Must be able to travel independently to provider sites, schools, courts, homes, and other community locations approximately 25–50% of the time. ENVIRONMENTAL CONDITIONS: Primary workspace is a heated and air-conditioned office. Duties require travel to provider locations, schools, homes, meetings, and other community settings as assigned. In-person attendance at FAPT, provider meetings, site visits, and other meetings may be required based on operational needs. To learn more about Frederick County, Virginia employee benefits, please visit the following webpage:https://www.fcva.us/departments/human-resources/employee-benefits
All positions are subject to a criminal background check for any convictions that relate to the job duties and responsibilities. Frederick County Virginia Government is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
The County’s EEO Utilization Report is available at www.fcva.us/jobs