Logo

Clinical Nurse Specialist (#334040)



DEFINITION

Provides consultation, education, evaluation, and quality improvement assessment for patient care, mental health medical facilities, contract provider activities, family members, consumers and the community; prepares, implements, and monitors Quality Improvement Plan for the mental health component of the Managed Care Program; may provide specialized mental health services to clients with complex psychiatric problems.

CLASS CHARACTERISTICS

This is a single position class that is characterized by the responsibility to provide advanced clinical nurse expertise in the evaluation and assessment of County contract providers of clinical mental health services within an evolving behavioral health managed care system.  The responsibilities include the design and implementation of inpatient and outpatient care management, quality improvement and control of service utilization in the Medi-Cal Managed Care System.
 

Supervision Received and Exercised

Receives general direction from the Deputy Director of Mental Health Services.
 
Provides technical supervision of lower level nursing staff.
 

Examples of Duties

  • Plans, organizes, and develops the quality improvement and utilization review plan for mental health managed care; monitors, schedules and reviews contract providers of psychiatric services in clinics, hospitals and other facilities on an annual basis; ensures standards of care.
  • Provides assessment, diagnosis and treatment as permitted under license for clients who present complex mental health related problems as needed; answers consumer access line as mandated by the state and evaluates client needs; assigns clients to appropriate mental health provider; coordinates activities and services with clients, families/guardians, psychiatrists, clinicians and mental health staff; completes authorization of services according to medical necessity. Implements and integrates cultural competency for clients with special and multicultural needs.
  • Performs service evaluations and prepares survey analysis and reports; reviews evaluations conducted by other state and federal medical evaluation teams to determine relevance and impact on County contract services; reviews outpatient treatment reports, psychiatric medication management and progress reports; performs utilization review of hospitalized clients with other facilities or agencies and professionals.
  • Conducts consumer eligibility checks.
  • Reviews service needs of individual Medi-Cal beneficiaries, evaluates pre-authorization and continuing authorization of services by contracted providers; secures and reviews health histories of patients, reviews and evaluates treatment plans.
  • Establishes and implements required grievance procedures and evaluates consumer complaints that arise within the mental health managed care system; determines preliminary corrective action, issues direction to provider and responds to consumers as appropriate.
  • Makes site visits to observe in-process mental health and medical services, reviews treatment plans and documentation at hospitals, clinics and private provider offices.
  • Investigates problems identified through the quality improvement and utilization review data evaluation process.  Provides the results of investigations to the Quality Improvement Committee and follows up by monitoring any corrective action identified for execution.
  • Provides consultation and education to department staff, contract providers, family members, consumers, and the community in solving problems as they arise in the provision of quality mental health services.
  • Motivates and instructs staff members in advanced technical nurse interventions in an interdisciplinary team environment; may assist in formal evaluation of medical programs and personnel in other county public health facilities.
  • Participates and provides leadership in client case conferences and other clinical coordination meetings.
  • Provides credentials for private contract providers.
  • Maintains professional knowledge in applicable areas and keeps abreast of changes in job-related rules, statutes, laws and new business trends; makes recommendations for the implementation of changes; reads and interprets professional literature; attends training programs, workshops and seminars as appropriate.

Knowledge, Skills & Abilities

Knowledge of:

  • Advanced knowledge of the principles, practices and skilled techniques of modern psychiatric nursing, medical and psychiatric terminology, current hospital and outpatient practices.
  • Knowledge of advanced nursing interventions that are used to achieve and maintain mental health through adaptive processes; to include psychodynamic theories related to anxiety, interpersonal relationships, crisis intervention and group processes.
  • Assessment and treatment/recovery techniques of persons with co-occurring substance abuse and psychiatric disorders.
  • National standards, state and federal laws relating to establishment and review of quality care in mental health managed care environment.
  • Psychological and sociological factors involved in administering medical/health services; principles of pharmacology, pharmakinetics, and pharmacodynamics and the related effects of major drug classes on patient care.

Skill to:

  • Operate office equipment including a personal computer, copy and fax machines and printers.

Ability to:

  • Work with physicians and other health professionals in clinic and hospital environments.
  • Plan, organize and administer a quality improvement review plan and develop recommendations for service delivery improvements.
  • Prepare comprehensive written reports of medical activities addressing all aspects of medical services from patient care, treatment plans, to physical facilities.
  • Communicate orally and make presentations to medical and health care staffs on quality improvement, medical and health care issues.

Education and Experience

  1. Three years of nursing experience in a clinic or hospital setting, one of which must have been reviewing and analyzing medical records and services for the purpose of compliance with quality improvement and utilization review standards.
  2. Possession of Master of Science Degree is required in Nursing from an accredited college or university; or Comparable Psychiatric Nurse Practitioner degree or certificate from an accredited college or university.

SPECIAL REQUIREMENTS

Possession of a valid license as a Registered Nurse and/or Nurse Practitioner in the State of California.
 
Possession of, or ability to obtain, a valid Class C California driver's license may be required.
 
Independent travel may be required.
 

ADA Compliance

Physical Ability:  Tasks require the ability to exert moderate, though not constant physical effort, typically involving some combination of climbing and balancing, stooping, kneeling, crouching, and crawling, and which may involve some lifting, carrying, pushing and/or pulling of objects and materials of moderate weight (12-20 pounds).
 
Sensory Requirements:  Requires the ability to recognize and identify similarities and differences between shade, degree or value of colors, shapes, sounds, forms, textures or physical appearance associated with job-related objects, materials, tasks or people.
 
Environmental Factors:  Tasks are regularly performed without exposure to adverse environmental conditions.

CLASS: 334040; EST: 8/1/1995;