Salary: 31.13-$38.00 hourly / $5,413-$6,609 monthly / Range: 6226
DEFINITION: Under general direction, conducts and coordinates
quality and utilization review activities of mental health inpatient
and outpatient services for the Alcohol, Drug & Mental Health
Services Department and for contracted providers; and performs
related duties as required.
Incumbents in this class work in a system of interdisciplinary
departmental teams and/or contract service agencies providing
assessment, prevention, intervention, treatment, and related
ancillary support services via an integrated service delivery system
to people with alcohol and other drug-related problems, mental
illness, and/or co-occurring conditions.
EXAMPLES OF DUTIES:
1. Develops and implements policies and procedures for the
utilization review function to assure the effective utilization of
medical or psychiatric services, and appropriate service
reimbursement; reviews requests for authorization of services to
determine whether the diagnosis and proposed treatment fall within
the criteria for service reimbursement and authorizes treatment or
refers the request to a higher medical authority; and authorizes
reimbursement of contracted inpatient and outpatient services.
2. Collects and reviews statistics of services provided using
automated systems to determine effectiveness and quality of care
provided and to assess whether changes in the program are necessary
to provide optimum health or psychiatric care in the most
cost-effective manner; and generates reports from automated system.
3. Works with beneficiaries, providers, co-workers, and other public
agencies to discuss or explain services provided or denied, give
direction or authorization for specialized treatments, and establish
eligibility of beneficiaries for services.
4. Collaborates with fiscal intermediaries, medical staff or mental
health professionals, and others to review and interpret patient
records and documentation when requests/claims for reimbursements
are denied; writes narrative and statistical reports on utilization
reviews; and prepares correspondence using word processing software.
5. Reviews state regulations; reviews policies and procedures and
makes recommendations to management on methods to conform to
regulations; educates staff on regulation changes; meets regularly
with care providers to identify and address utilization review
issues; and conducts training sessions for clinical and support
staff on utilization review and documentation.
6. Assigns, reviews, and evaluates the work of professional,
technical, and clerical staff.
1. Three years of clinical experience as a licensed mental health
professional as defined by California Code of Regulations, Title 9,
Chapter 11, �1770 (including registered nurses, licensed clinical
social workers, and marriage and family therapists). Work must have
included some experience planning, organizing, and evaluating
program operations and staff; or,
2. three years of clinical experience as an ASW or MFT intern or
other waivered/registered Point of Authorization staff as defined by
California Code of Regulations, Title 9, Chapter 11, �1770 and
1820.200. Work must have included some experience planning,
organizing, and evaluating program operations and staff; or,
3. a combination of training, education, experience, and licensure
or registration that is equivalent to one of the employment
standards listed above and that provides the required knowledge and
Professional Licensure: Where licensure is required, applicants must
possess licensure in their profession at the time of application.
Initial appointment may be based upon comparable licensure in any
state; however, California licensure is required within two years of
appointment as a condition of continued employment.
Additional Requirements: This position requires travel within the
County on a weekly basis. A valid driver's license is required at
the time of application. A valid California Class C Driver's License
is required at the time of appointment.
Knowledge of: State regulations applicable to treatment and
reimbursement under Medi-Cal and other third party payers; basic
utilization review procedures and techniques; medical and surgical,
mental health, or alcohol and drug diagnoses, procedures, and types
of treatment; basic principles and practices of supervision; and
English grammar and usage.
Ability to: prepare and maintain accurate records; interpret rules
and regulations; read and understand patient records; work tactfully
and effectively with staff, patients, families, fiscal
intermediaries, and providers; prepare clear and concise reports
using correct grammar, punctuation, and spelling; maintain
objectivity and confidentiality; gather and analyze data, draw
conclusions, and make recommendations; communicate effectively, both
one on one and in groups; and use word processing, spreadsheet, and
database applications on personal computer.
Background Investigation: Finalists for positions in this class will
be required to pass a pre-offer, job-related background