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Quality Assurance Coordinator

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.

EMPLOYMENT STANDARDS:

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 abilities.

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 investigation.

 



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