Quality Care Management Coordinator

County of Santa Barbara•Santa Barbara, CA

1d•Hybrid

About The Position

The County of Santa Barbara Behavioral Wellness Department is seeking to fill a Quality Care Management (QCM) Coordinator vacancy. This full-time position may be based at any County work location within Santa Barbara County, with travel required between Santa Barbara, Santa Maria, and Lompoc. The role offers some flexibility for hybrid remote work, subject to departmental needs, with remote work locations required to be within California. The working title is Quality Care Management Coordinator, and the associated County job classification is Quality Assurance Coordinator. This position is part of the Quality Care Management division and reports to the Quality Care Management Program Manager. The incumbent will conduct and coordinate quality improvement and utilization review activities for mental health and alcohol and other drug services for the Department of Behavioral Wellness and its contracted providers. This role involves working within interdisciplinary teams and with contract service agencies providing a range of services to individuals with alcohol and other drug related problems, mental illness, and/or co-occurring conditions.

Requirements

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 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 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.
A valid California Class C Driver’s License will be required at the time of appointment.
Knowledge of State regulations applicable to treatment and reimbursement under Medi-Cal and other third party payers.
Knowledge of basic utilization review procedures and techniques.
Knowledge of medical and surgical, mental health, or alcohol and drug diagnoses, procedures, and types of treatment.
Knowledge of basic principles and practices of supervision.
Knowledge of English grammar and usage.
Ability to prepare and maintain accurate records.
Ability to interpret rules and regulations.
Ability to read and understand patient records.
Ability to work tactfully and effectively with staff, patients, families, fiscal intermediaries, and providers.
Ability to prepare clear and concise reports using correct grammar, punctuation, and spelling.
Ability to maintain objectivity and confidentiality.
Ability to gather and analyze data, draw conclusions, and make recommendations.
Ability to communicate effectively, both one on one and in groups.
Ability to use word processing, spreadsheet, and database applications on personal computer.

Nice To Haves

Knowledge of California Mental Health Plan and Drug Medi-Cal Organized Delivery Systems including recently enacted laws tied to the Managed Care Final Rule and Drug Medi-Cal Organized Delivery System.
Demonstrated ability to develop and maintain sound working relationships with people of diverse backgrounds and personalities.
Experience in clinical and/or managed care planning and oversight.
Strong background as a licensed mental health professional.
Experience and/or education in alcohol and other drug services.
Detail oriented while handling multiple projects with competing priorities.
Processes, interprets and communicates complex contractual information to internal and external clients.
Open to change and new information and ability to adapt behavior and work methods in response to new information, changing conditions, and unexpected obstacles.
Bilingual skills in English/Spanish are highly desirable but not required.

Responsibilities

Develops and implements policies and procedures for the quality improvement 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.
Authorizes reimbursement of contracted inpatient and outpatient services.
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.
Generates reports from automated systems.
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.
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.
Prepares correspondence using word processing software.
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 quality improvement issues.
Conducts training sessions for clinical and support staff on documentation.
Assigns, reviews, and evaluates the work of professional, technical, and clerical staff.