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.
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.
Review patient admission data and clinical documentation to ensure compliance with county and state regulations relating to medical necessity and case documentation; when appropriate, interview clients, significant others, and consult with existing out-patient team; consult with medical and treatment staff regarding patient diagnosis, medical justification, length of treatment, and case documentation; assess records for appropriate level of care and treatment, aftercare, and discharge planning for patients; represent the County in disagreements as to care plans with medical staff at hospitals; advocate for required patient treatment with medical providers; provide training and information about utilization requirements to clinical, supervisory, and management staff; participate with departmental staff in utilization and quality improvement meetings and projects; prepare memorandum, letters, correspondence and comprehensive daily patient status summaries; and participate in state and federal audits of programs to ensure agency compliance on utilization review regulations.
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.
Bargaining Unit: 41
EEOC Job Category: 02
Occupational Grouping: 50
Workers' Comp Code: 0290