The Commonwealth of Pennsylvania is seeking a dedicated and qualified individual to fill the position of Mental Health and Drug Abuse Advocate, based in Philadelphia, Pennsylvania. The ideal candidate will possess a strong background in mental health and/or drug addiction counseling, as well as investigative and auditing experience. This vital role plays a crucial part in ensuring the delivery of high-quality healthcare services and compliance with health regulations within the community.
Key Responsibilities:
Healthcare Auditing: Conduct thorough and systematic audits of healthcare facilities and service providers to assess compliance with regulations and standards related to community health, mental health, and drug addiction services.
Mental Health and Drug Addiction Expertise: Leverage a deep understanding of mental health and drug addiction counseling to evaluate the quality and effectiveness of treatment programs, patient care, and prevention efforts in the community.
Investigation: Conduct investigations into allegations of misconduct, fraud, or violations within community health programs. Gather evidence, interview witnesses, and compile detailed reports for further action.
Data Analysis: Analyze healthcare data, patient records, and service outcomes to identify trends, disparities, and potential areas for improvement in community health services. Utilize this analysis to make data-driven recommendations.
Regulatory Compliance: Stay up-to-date with federal and state healthcare regulations, policies, and guidelines. Ensure that healthcare facilities and programs within the community adhere to all relevant laws and regulations.
Reporting: Prepare detailed reports summarizing audit findings, investigations, and compliance assessments. Communicate findings to relevant stakeholders, including government agencies, healthcare providers, and community organizations.
Collaboration: Collaborate with a multidisciplinary team of healthcare professionals, auditors, and regulatory authorities to address compliance issues, improve services, and facilitate positive changes within the community.
Community Engagement: Engage with community members, advocacy groups, and healthcare stakeholders to gather insights, identify challenges, and address the unique needs of the community.
Requirements
Bachelor's or Master's degree in a related field (e.g., Mental Health Counseling, Drug Addiction Counseling, Public Health, Social Work)Proven experience in healthcare auditing and investigation, preferably in a community health context.In-depth knowledge of mental health and drug addiction treatment methodologies, practices, and best practices.Are you a registered nurse ready to take your career in an exciting new direction—one where your expertise truly makes a difference? Join Pennsylvania’s premier Quality Improvement Organization and step into a dynamic role focused on advocacy and program integrity through compliance management. Here, you’ll champion the needs of vulnerable populations, safeguard the quality of care, and influence healthcare outcomes on a meaningful scale. Enjoy the freedom of working from home, the flexibility and autonomy to manage your workday, and the opportunity for continuous professional growth—all while being part of a passionate, mission-driven team dedicated to improving healthcare across the Commonwealth.
In this rewarding role, you’ll use your clinical knowledge outside of the traditional bedside setting to review and audit claims, support program integrity initiatives, and advocate for beneficiaries across the Commonwealth. You’ll enjoy the flexibility of working from home, the autonomy to manage your work, and meaningful opportunities for professional growth—all while contributing to a mission that truly matters.
What You’ll Do
Conduct clinical reviews and ensure quality, appropriateness, and compliance with healthcare standards
What We’re Looking For
Active, unrestricted Registered Nurse (RN) licenseExperience in utilization review, case management, quality improvement, compliance, or claims review is a plus—but not required.
Why Join Us
Mission-driven work with Pennsylvania’s leading Quality Improvement Organization
If you’re a registered nurse seeking purpose-driven work, professional growth, and the flexibility to balance your life and career—this is your opportunity. Apply today and help shape the future of healthcare quality in Pennsylvania.
Requirements
Be available as a full-time consultant, approximately 37.5 hours per week;
Possess a current license to practice as a Registered Nurse issued by the Pennsylvania
State Board of Nursing; or possess a non-renewable temporary practice permit issued
by the Pennsylvania State Board of Nursing. Resources possessing non-renewable
temporary practice permits must obtain licensing as a Registered Nurse within the
one-year period as defined by the Pennsylvania State Board of Nursing;
Possess a documented work history of three (3) or more years of professional
experience with medical assistance, health care services or human services or any
equivalent combination of experience and training;
Possess basic computer skills, including familiarity with Microsoft Office programs.
Principal Duties and Responsibilities (RN – Utilization Review / Program Integrity)
Conduct clinical utilization reviews by evaluating medical records, treatment plans, and supporting documentation to determine medical necessity, appropriateness, quality, and level of care in accordance with Medical Assistance (MA) program requirements.