Powered by JobAps


Logo

Mental Health Utilization Review Specialist (#SK7 )
$51.31-$64.89 hourly / $8,893.56-$11,247.38 monthly / $106,724.80-$134,971.20 yearly

Definition

Under general supervision, review medical records of patients who are under treatment for emotional or mental illness to ensure proper utilization of treatment resources; review patient records for proper case documentation, and medical necessity of treatment in relation to federal, state and county regulations; assess continuing treatment plans; advocate for required patient treatment with medical providers; and perform other duties as required.

Distinguishing Characteristics

This classification differs from Mental Health Supervising Client specialist in that the latter supervises and evaluates the work of professional employees and assists in managing and directing a program area while providing advanced journey level professional services to clients, while the Mental Health Utilization Review Specialist reviews patient records to ensure proper and necessary treatment. This classification is distinguished from the higher level Program Manager in that the latter is responsible for the management and over-all quality/ effectiveness of a major divisional unit with multiple programs providing direct client services, while the Mental Health Utilization Review Specialist reviews patient records to ensure proper and necessary treatment.

Typical Tasks

  • Review patient admission data and clinical documentation to ensure compliance with county and state regulations related to medical necessity and case documentation;
  • When appropriate, interview clients and significant others and consult with existing outpatient treatment teams;
  • Consult with medical and treatment staff regarding patient diagnosis, medical justification, length of treatment, and case documentation;
  • Assess records to determine appropriate level of care, treatment needs, aftercare, and discharge planning;
  • Represent the County in resolving disagreements with hospital medical staff regarding care plans;
  • Advocate for required patient treatment with medical providers;
  • Provide training and information on utilization requirements to clinical, supervisory, and management staff;
  • Participate in departmental utilization review and quality improvement meetings and projects;
  • Prepare memoranda, letters, correspondence, and comprehensive daily patient status summaries;
  • Participate in state and federal audits of programs to ensure compliance with utilization review regulations.

Employment Standards

EMPLOYMENT STANDARDS

Knowledge of:

Thorough knowledge of:

  • Psychological and social aspects and characteristics of emotional disturbances and mental illness;
  • Principles and methods of counseling and the accepted techniques for assessing psycho-social behavior.

Working knowledge of:

  • Human behavior and development;
  • Appropriate and available community resources;
  • Problems, needs and attitudes of the emotionally ill and socially disturbed;
  • Pertinent laws and regulations regarding health and social service pro grams;
  • Federal, state and county regulations pertaining to utilization review;
  • Laws and regulations as they pertain to clients' legal rights;
  • Pharmacology of medications and psychotropic drug treatment;
  • Methods and procedures of admissions, discharges and patient care in acute care psychiatric facilities.

bility to:

  • Communicate effectively in oral and written format;
  • Maintain effective interpersonal relationships;
  • Understand and apply state, federal and local regulations and laws governing quality assurance and utilization review;
  • Work independently;
  • Analyze treatment plans, which include the diagnosis of client behavioral and emotional problems;
  • Use good judgment in order to make critical decisions about the medical necessity of treatment;
  • Work in a high stress, chaotic environment.

Education and Experience:

Any combination of education and experience, which would provide the required knowledge and abilities, is qualifying, unless otherwise specified. A typical way to obtain the knowledge and abilities would be:

Possession of a Master's Degree with a major in Social Work, Psychology, Psychiatric Nursing, Marriage and Family and Child Counseling, Registered Nursing or a closely related science field which has included completion of a university approved internship and the equivalent to one year of experience at the level of Senior Mental Health Client Specialist.

Special Requirements, Conditions:

License, Registration: Possession of a license as a Clinical Social Worker, Marriage and Family and Child Counselor, Clinical Psychologist, or Registered Nurse.

Background Investigation: Fingerprinting is required.

EST: 9/95 REV: Analyst: JS

Miscellaneous

PREVIOUS CLASS TITLES: None

Bargaining Unit: 41

EEOC Job Category: 02

Occupational Grouping: 50

Workers' Comp Code: 0290

Analyst: JS

CLASS: SK7; EST: 9/1/1995;