Open To Work
WILLIAM CHONG
Tustin,CA
Work Preference
Summary
Senior Clinical Director and Utilization Review Specialist with 15+ years of experience conducting medical necessity reviews, documentation integrity oversight, level-of-care determinations, and payer-facing clinical review across Medi-Cal, commercial insurance, and regional center systems. Experienced applying criteria-based decision-making aligned with InterQual and ASAM logic, and actively expanding formal training in InterQual, ASAM, GASC, and payer-specific UM frameworks. Proven track record of achieving zero documentation-related denials, maintaining 100% audit readiness, and scaling regional operations while ensuring compliance with medical necessity standards and payer expectations.
Overview
18
18
years of professional experience
Work History
Clinical Director
Creative Solutions for Hope
01.2018 - Current
- Achieved zero documentation-related denials by implementing a documentation integrity system that ensures alignment with UM criteria and regulatory requirements.
- Train clinicians on documentation standards aligned with functional impairment, risk assessment, and payer expectations, improving documentation accuracy by 40%.
- Scaled regional operations by 1,100% (5 → 60 clients) and increased revenue by 60% through optimized authorization workflows and improved care coordination.
- Conduct clinical authorization readiness reviews to ensure treatment plans meet medical necessity standards, functional impairment criteria, and payer expectations; request revisions when goals are academic or not criteria-aligned.
- Responded to payer requests for information (RFIs) with data-driven clinical justifications and mitigation plans, supporting favorable authorization decisions.
- Prepared clinical narratives to address limited progress, regression, or barriers, ensuring alignment with medical necessity and continued-stay criteria.
- Perform level-of-care determinations by analyzing progress trends, regression patterns, participation barriers, and environmental factors impacting treatment efficacy.
- OC & Bay Area, CA
Clinical Supervisor
Creative Solutions for Hope
01.2008 - 01.2018
- Improved treatment fidelity by 30% through competency-based training and structured supervision.
- Trained staff on documentation standards focusing on functional impairment, risk assessment, and medical necessity to enhance compliance and improve service delivery.
- Reviewed treatment plans for medical necessity, functional relevance, and measurable outcomes; facilitated revisions to meet compliance standards.
- Supported level-of-care decisions by analyzing progress, regression, and participation barriers.
- Conducted documentation audits to verify accuracy, completeness, and adherence to payer expectations, ensuring quality standards were met.
- Responded to payer inquiries by gathering progress data, summarizing clinical trends, and preparing mitigation plans.
- Costa Mesa, CA
Education
M.Ed. - Applied Behavior Analysis
University of Cincinnati
B.A. - Psychology
University of California, Irvine
Skills
- Medical Necessity Review
- Clinical Authorization Readiness Review
- Criteria-Based Decision-Making (InterQual/ASAM-Aligned)
- Payer Request for Information (RFI) Response
- Level-of-Care Determination
- Prior Authorization Support
- Documentation Integrity (CDI)
- Audit Readiness
- Functional Impairment Assessment
- Risk & Regression Analysis
- Service Intensity Titration
- Clinical Operations Leadership
- Staff Development (BCBAs, PMs, RBTs)
- Quality Assurance
- Cross-Functional Collaboration
- Care Coordination & Transitions
- Regulatory Compliance (SB 855, AB 951, EPSDT, GASC)
Caqh
14112494
Npi
1285168104
Bcba
#1-17-25659
Timeline
Clinical Director
Creative Solutions for Hope
01.2018 - Current
Clinical Supervisor
Creative Solutions for Hope
01.2008 - 01.2018
M.Ed. - Applied Behavior Analysis
University of Cincinnati
B.A. - Psychology
University of California, Irvine