The Mental Health Utilization Review (UR) Coordinator is responsible for utilization review activities with respect to mental health services provided by Health and Human Services Agency (HHSA) staff or by providers under contract with HHSA. The incumbent in this position is concerned with outpatient and residential services provided by HHSA staff within the Mental Health Division or by providers under contract with HHSA and youth treatment services provided under contract with HHSA.
The most successful applicants for this position will possess a valid California license issued by the Board of Behavioral Sciences in one of the following areas:
Licensed Clinical Psychologist;
Licensed Clinical Social Worker;
Licensed Marriage, Family and Child Therapist.
EXAMPLE OF DUTIES
The following duties are typical for this classification. Incumbents may not perform all of the listed duties and/or may be required to perform additional or different duties from those set forth below to address business needs and changing business practices.
Develop and operate a system for the authorization of placements of consumers by HHSA in acute psychiatric hospitals, sub-acute crisis stabilization, rehabilitation, and transitional facilities, institutions for the mentally disordered, and other residential mental health treatment facilities; conduct concurrent and retrospective reviews to ensure the appropriateness and effectiveness of treatment in these facilities, including the duration and nature of treatment provided; maintain cumulative documentation regarding treatment activities and initiate action when stays or services are not appropriate; develop and coordinate a system for the authorization, concurrent review, and if appropriate, retrospective review, of all outpatient mental health services being provided by HHSA staff, including: psychiatric services, crisis intervention services, and case management; conduct technical reviews of such activities as intake, assessment, treatment planning, ongoing service delivery, and discharge planning; conduct clinical reviews to ensure that appropriate diagnoses are being made, adequate assessment occurs, treatment interventions are appropriate, appropriate clinical progress occurs, and the client continues to be in need of service; provide comparisons of services provided through MH staff and by staff of other divisions or programs to ensure that there is no duplication of case management of other services funded by a single state or federal source; conduct general reviews to ensure that services and documentation conform to the community standard of care, the Agency's policies and procedures, applicable laws and regulations, and the requirements of funding sources; maintain appropriate documentation; act as the MH division liaison to the Agency's Fiscal Division; serve as chair of the Mental Health Billing Workgroup and maintain appropriate documentation of the workgroup's activities, including documentation of the disposition of matters referred to or raised within the Workgroup; serve as a conduit for, and review and approve, all Billing Change Forms and other documents communicating with the Fiscal Division. Review and approve all changes in billing service codes used within the MH Division and provide for their assimilation into UR screens and other review documents; in collaboration with the Mental Health Quality Coordinator and the Quality Management Division, participate in QM reviews of case documentation for persons receiving outpatient MH services for HHSA staff, where review protocols call for participation by both QM and MH division staff. Participate in the development of monitors, in the Agency QM plan that pertains to the services for which the UR Coordinator is responsible for utilization review within the MH division. Regularly review the results of audit or other tracking conducted by the QM division. Participate in the analysis of such results both to confirm inter-rater reliability between the QM reviewers and the coordinator or other reviewers within the MH division. Assist in the development of interventions and action plans with respect to reviewed services which do not meet expectations for compliance to applicable standards; in collaboration with the Fiscal Division, periodically coordinate a review of samplings of fiscal and clinical records to confirm that services are being appropriately and accurately billed; regularly advise the MH Director and MH Management Team regarding the levels of compliance in service delivery, documentation and billing for mental health services by each Agency program.
EXPERIENCE AND EDUCATION
To qualify for this classification, an individual must possess any combination of experience and education that would likely produce the required knowledge, skills, and abilities. Required minimum qualifications:
Experience: Four or more years of employment in a program delivering mental health and/or alcohol and drug services supported through state and/or federal funding. Mental Health experience is highly desired.
Education: A Master's degree in behavioral health or a closely related discipline.
License: Possession of one of the following valid licenses issued by the State of California: Licensed Clinical Psychologist; Licensed Clinical Social Worker; Licensed Marriage, Family and Child Therapist.
*Licensed Professional Clinical Counselor (LPCC) must include the additional training and education to treat couples or families, as required under BPC section 4999.20(a)(3)(A).
Other Requirements: Incumbents in this class must be willing to work evenings and/or weekends as needed at an out-station location or in a setting with other professionals integrated as a team.
Internal Number: HHSURCMH
About Napa County
The County of Napa is a highly respected employer within the local community as well as throughout the region. We offer rewarding and challenging work, flexible hours, competitive salaries, a comprehensive benefits package and tremendous opportunities for career growth. At the County of Napa we truly value our employees and are committed to diversity in our family-oriented environment. This is why we are the Employer of Choice for more than 1,400 employees.
As an organization, the County is dedicated to improving the lives of our citizens and reflecting the best of the community's values: Respect, Accountability, Dedication, Integrity and Innovation.
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