County of Alameda

DESCRIPTION

Under general direction, assists the Quality Assurance Administrator in the development, implementation and coordination of the Quality Assurance and Improvement (QAI) Program for Behavioral Health Care Services (BHCS); conducts quality assurance and authorization activities across all County operated and contracting clinical programs within BHCS; and performs other duties as required.

DISTINGUISHING FEATURES

This is a single class position located in the Behavioral Health Care Services Department in the Health Care Services Agency and reports to the Quality Assurance Administrator. This position supports the Quality Assurance Administrator in planning, implementing, coordinating and evaluating the QAI Program. This position provides behavioral care treatment and claims reviews, provider consultation, and clinical supervision/consultation to other staff rendering direct care or engaged in quality assurance or authorization activities. This position is distinguished from the next higher class of Quality assurance Administrator in that the latter has overall policy development and administrative responsibility for the Quality Assurance and Improvement Program.

EXAMPLES OF DUTIES

NOTE: The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Each individual in the classification does not necessarily perform all duties listed.

1. Coordinates, directs and supervises quality review activities including all activities of the Clinical Quality Review Teams (CQRT) Program; ensures CQRT process compliance of contract and county operated programs; acts as a team leader; and provides clinical supervision and training to clinical staff related to quality assurance functions.
2. Develops, revises and interprets relevant policies and procedures; and reviews policies and procedures to ensure compliance with departmental, Federal and State requirements.
3. Designs, coordinates and conducts training programs/workshops for BHCS, contract organizations and independent providers; and provides Continuing Education Units (CEU’s) for licensed clinicians and maintains required records for auditing purposes.
4. Conducts and/or facilitates internal and external audits, investigations and program reviews to determine potential clinical and compliance risks; and analyzes data, provides finding and recommendation reports to administrative staff, and ensures “plans of correction” are implemented.
5. Develops and revises a variety of forms/templates to ensure consistency and compliance with regulatory requirements and clinical standards.
6. Maintains current Quality Assurance Office information in manuals, handbooks, web pages and other related sources in accordance with BHCS and regulatory agencies’ standards, and Federal/State laws.
7. Chairs and/or participates in various committees and work groups (e.g., QA and QIC meetings, Compliance Committee, CASP, EPSDT Contract Committee, Northern California Quality Improvement Coordinators Committee).
8. Supervises consumer Assistance Office and QA Office staff as assigned and in the absence of the QA Administrator. Supervises, trains and/or evaluates assigned staff that assists in the implementation of programs.
9. Provides consultation to BHCS staff and contract organizations/providers on State, Federal, County and ACBHCS policies, laws and regulations; assists contractors in determining the application of policy to their organizations; and reviews contract provider policies and manuals to assist in determining compliance with oversight bodies.
10. Provides case consultation concerning medical necessity and utilization of system resources; and assesses level of care, treatment and disposition plan within age-related parameters and assures that adequate documentation exists to substantiate provision of services and payment authorization.
11. Evaluates clinical needs and makes appropriate referrals for care; makes complex decisions about responsibility for payment; and evaluates client resources and available insurance plans to determine client eligibility for services and Behavioral Health Care Services sources of reimbursement.
12. Develops utilization case management intervention and records clinical information, interventions and payment authorization decisions.
13. Interacts with medical director to seek/provide consultation (e.g. cases with clinical issues and potential denials of service); participates and may lead in clinical case review conferences.

MINIMUM QUALIFICATIONS

Education:

Possession of a Master’s degree from an accredited college or university in a health care field.
AND

Experience:

The equivalent of two (2) years post Master’s level experience in planning, implementing, coordinating and evaluating a Quality Assurance and Improvement Program or conducting quality assurance and authorization activities in a health care setting.

License:

• Possession of a valid Clinical Social Work, Marriage and Family Therapist, Clinical Psychology or Registered Nurse CA license from the applicable licensing authority.
• Possession of a valid California Motor Vehicle Operator’s license.

NOTE: The Civil Service Commission may modify the above Minimum Qualifications in the announcement of an examination.

KNOWLEDGE AND SKILLS

NOTE: The level and scope of the following knowledge and abilities are related to duties listed under the “Examples of Duties” section of this specification.

Knowledge of:

• Principles and practices of clinical systems, quality management/improvement/assurance, and risk management principles in a managed behavioral health care setting.
• Organization and functioning of a managed behavioral health care setting.
• Current applicable federal, state, county laws, codes, and regulations and their reporting requirements.
• Reimbursement criteria and documentation and coding requirements for Medicare, Medi-Cal, HMO, PPO, and other common sources of reimbursement.
• Audit protocols for Medi-Cal and Medicare documentation.
• Behavioral health care clinical issues and management, public health planning, and quality management in a system of care.
• QA measurement and assessment principles and techniques.
• General administrative practices and principles; staff leadership and consultation skills.
• Community standards of quality clinical practice, diagnosis, assessment, treatment planning and documentation.
• Social and behavioral aspects of mental and emotional disturbances and their characteristics.
• Principles and practices of direct client service delivery.
• Scope, activities and functions of the various behavioral health facilities and public and private community agencies providing services to behavioral health clients.
• Policies, procedures, and systems related to behavioral health care services.

Ability to:

• Plan, prioritize and organize.
• Communicate orally and in writing.
• Make decisions.
• Analyze and problem solve.
• Maintain accurate records.
• Manage multiple tasks and responsibilities.
• Consult, lead and exhibit team facilitation skills.
• Exhibit flexibility and adapt to frequent changes in regulations and requirements.

CLASS SPEC HISTORY

TE:po 2/7/06
Newspecs: 5081.doc
CSC Date: 3/15/2006

BENEFITS

Alameda County offers a comprehensive and competitive benefits package that affords wide-ranging health care options to meet the different needs of a diverse workforce and their families. We also sponsor many different employee discount, fitness and health screening programs focused on overall well being.  These benefits include but are not limited to*:

For your Health & Well-Being

• 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, Hospital Indemnity and Legal Services
• Employee Assistance Program

For your Financial Future

• Retirement Plan - (Defined Benefit Pension Plan)
• Deferred Compensation Plan (457 Plan or Roth Plan)

For your Work/Life Balance

• 12 paid holidays
• Floating Holidays
• Vacation and sick leave accrual
• Vacation purchase program
• Management Paid Leave**
• Catastrophic Sick Leave
• Group Auto/Home Insurance
• 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
• 1^st United Services Credit Union 

*Eligibility is determined by Alameda County and offerings may vary by collective bargaining agreement.  This provides a brief summary of the benefits offered and can be subject to change.

** Non-exempt management employees are entitled to up to three days of management paid leave. Exempt management employees are entitled to up to seven days of management paid leave.