Clinical Review Specialist

County of Alameda • Oakland, CA

1d

About The Position

Under general direction, to provide behavioral care services by telephone, face-to-face, and/or record review for referral, treatment, and/or payment authorization and service integration; to gather and analyze case history data and treatment plans; to make treatment recommendations and to assess quality of care; to record all findings and maintain review records; and to do related work as required. Clinical Review Specialist positions are located in the Department of Behavioral Health Care Services ACCESS Program, Authorization Services and Quality Assurance. These positions provide a variety of clinical services including screenings and referrals, face to face assessments, review of medical necessity for authorization of services, utilization review, assessment of quality of care, and provider consultation. This is a journey level class, requiring a licensed professional, fully trained and professionally skilled upon entrance into the class. This position reports to a licensed clinical manager. Direct supervisory review and guidance is provided only in selected cases. Clinical Review Specialists provide behavioral care clinical assessment, clinical analysis, referral for treatment, treatment review, and provider consultation involving considerable latitude and independence of judgment. Incumbents in this class may lead and consult with other staff on clinical issues but do not have formal supervisory responsibility. The class is distinguished from Behavioral Health Clinician II, Clinical Psychologist and Clinical Nurse II positions in that incumbents usually perform tasks using indirect information but may use direct interactions to provide behavioral health screenings and referrals, level of care assessments, or clinical direction to other licensed professionals and a large network of independent practitioners and organizations. This direction may include payment authorization, resource utilization management, quality improvement, quality assurance and coordination of multiple funding sources to support treatment requests.

Requirements

• Possession of a Master’s Degree from an accredited college or university in Social Work, Marriage and Family Therapy, Psychiatric Nursing, with an emphasis in Clinical Social Work, or equivalent degree which meets requirements set by the California Board of Behavioral Sciences; OR A Ph.D. in clinical, counseling, or educational psychology from an accredited college or university.
• Completion of an accredited registered nursing program, including three years post licensed nursing experience may be substituted for a Master’s degree in nursing.
• The equivalent of three years of full-time, paid post-license experience in direct behavioral health care that includes treatment and disposition planning and/or the clinical review of these direct mental health and substance use disorder services.
• Possession of a valid clinical license from the applicable licensing authority: California Board of Behavioral Sciences, California Board of Psychology, or California Board of Registered Nursing.
• Possession of a valid California Motor Vehicle Operator’s license.
• In compliance with the Administrative Simplification provision of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), employees in this classification are required to possess a National Provider Identifier (NPI) number prior to their first day on the job.

Nice To Haves

• Licensed and experienced clinical professionals who are adept at securing relevant client care data and identifying key issues and relationships in a behavioral health managed care setting; who understands the relationships among assessments, interventions, and patient responses; and who are skilled in conducting behavioral health assessments and utilization and quality assurance reviews in order to refer clients to or evaluate medical necessity of services within the Alameda County network of service providers.
• Professionals who would take personal satisfaction and pride representing the County and serving as part of a team directly responsible for either providing initial clinical screening and service referrals over the telephone in a fast-paced, high volume call center environment or providing quality assurance and utilization review of clinical resources.
• Resourceful and adept at seeking or collecting and synthesizing information from a variety of clients and sources in an objective, unbiased manner to reach a sound conclusion, goal, or judgment.
• Collaborative spirits eager to actively participate as a member of a team contributing successfully to the completion of goals and objectives aligned with the mission, vision and values of the Behavioral Health Care Services system of care
• Practiced problem solvers capable of making well supported decisions by identifying and understanding issues, problems, and opportunities; comparing data from different sources to draw conclusions; using effective approaches for choosing a course of action; and solving problems by taking action that is consistent with available facts, constraints, and probable consequences.
• Well organized, capable of multi-tasking and planning daily work activities, and establishing a course of action for self and others to ensure that work is completed efficiently.
• Effective communicators who convey information and ideas verbally and in writing in a manner that meets audience needs; and develops and maintains effective relationships with others by relating well to people with diverse cultures, interpersonal styles, abilities, motivations, or backgrounds

Responsibilities

• Provide behavioral care services by telephone, face-to-face, and/or record review for referral, treatment, and/or payment authorization and service integration
• Gather and analyze case history data and treatment plans
• Make treatment recommendations and to assess quality of care
• Record all findings and maintain review records
• Provide behavioral care clinical assessment, clinical analysis, referral for treatment, treatment review, and provider consultation
• Lead and consult with other staff on clinical issues

Benefits

• Medical – HMO & PPO Plans
• Dental – HMO & PPO Plans
• Vision or Vision Reimbursement
• Share the Savings
• Basic Life Insurance
• Supplemental Life Insurance (with optional dependent coverage for eligible employees)
• Accidental Death and Dismemberment Insurance
• County Allowance Credit
• Flexible Spending Accounts - Health FSA, Dependent Care and Adoption Assistance
• Short-Term Disability Insurance
• Long-Term Disability Insurance
• Voluntary Benefits - Accident Insurance, Critical Illness, Long-Term Care, Hospital Indemnity and Legal Services
• Employee Assistance Program
• Retirement Plan - (Defined Benefit Pension Plan)
• Deferred Compensation Plan (457 Plan or Roth Plan)
• 12 paid holidays
• Floating Holidays
• Vacation and sick leave accrual
• Vacation purchase program
• Catastrophic Sick Leave
• Pet Insurance
• Commuter Benefits Program
• Guaranteed Ride Home
• Employee Wellness Program (e.g. At Work Fitness, Incentive Based Programs, Gym Membership Discounts)
• Employee Discount Program (e.g. theme parks, cell phone, etc.)
• Child Care Resources
• 1st United Services Credit Union

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees