Clinical Utilization Specialist

2 weeks ago

Wichita, United States Saint Francis Ministries Full time
Job Description

The Clinical Utilization Specialistprovides clinical program review, direction and consultation and monitors services provided to children/families to ensure that these services are timely, appropriate, and effective for children with high acuity needs in Out Of Home care (OOH).

Requirements

JOB REQUIREMENTS:

Minimum Education Licensure/Certifications-

  • Bachelor's Degree in Social Work or Addictions Counseling from an accredited college or university.

Minimum Work Experience-

  • Two years experience in the mental health or behavioral health care field.

Minimum Job Requirements-

  • Must be 21 years of age.
  • Must pass drug screen, MVR, KBI, Child Abuse and Neglect Central Registry Clearance check and an Adult Registry check
  • FBI Fingerprint check if relocated to Kansas in the last 5 years
  • Lifting requirement of 50 lbs.
  • Must have valid driver's license, acceptable driving record and reliable transportation

Essential Functions-

  • Reviews and authorizes all requests for attaining highest level of care (acute/QRTP/PRTF) for children/ youth in our care
  • Requests, participates and facilitates all QRTP and PRTF authorizations for admission, plan of care/treatment reviews, discharge meetings, and appeals.
  • Appropriately documents all reviews and assures entry of all pre-certifications/authorizations into the child management system (CMS). Notifies all providers that services have been approved.
  • Participates in consultations involving all parties involved in the care of the child (foster parent, case management team etc.) to consider higher levels of care.
  • Liaisons with Medicaid entity (MCO) for admission to Medicaid reimbursed treatment facilities.
  • Liaisons with QRTP's, PRTF's and Acute Hospitals.
  • Determines appropriate RTP and PRTF setting for admission based on individual needs.
  • Works as a team and participates in placement process for children and youth leaving the highest level of MH care.
  • Works collaboratively with Clinical Utilization and Care Center placement staff regarding placements of children and youth that require higher levels of service/care.
  • Ensures quality services are in place for children and families.
  • Utilizes trauma systems therapy model of care.
  • Participates in Clinical Utilization on-call rotation.
  • Reports critical incidents to DCF verbally within 12 hours, written within 24 hours
  • Implements Saint Francis Ministries policies and follows directives as required. Follows and adheres to all pertinent Saint Francis Ministries Standard Operating Procedures (SOP's), rules, personnel policies and procedures; related accreditation and licensure standards; and federal, state and local rules, statutes, regulations, and contractual terms
  • Reports unusual incidents through appropriate Risk Management, clinical and safety channels.
  • Ensures clients' rights are protected.
  • Is knowledgeable of and follows all safety procedures.

Required Skills, Knowledge, and Abilities-

  • Mandated Reporter.
  • Demonstrate effective written and verbal communication skills.
  • Basic understanding of family centered practice, child development, family systems, and treatment.
  • Working knowledge of counseling techniques, individual, group, and family.
  • Understanding of standards of care for mental health services and levels of care for placement.
  • Understanding of the child welfare and state foster care/adoption system.
  • Understanding of mental health state systems and Medicaid systems.
  • Must be a team player.
  • Must have understandings of genograms, ecograms, and social histories.
  • Flexible to changing situations, staff and youth.
  • Sensitive to the needs of youth and their families.
  • Able to solve problems but also able and willing to seek assistance when necessary.
  • Understands child and adolescent therapeutic techniques and how this impacts the client.
  • Independent discretion/decision making within the scope and responsibility of the position.
  • Ability to think critically and objectively as well as evaluate needs and progress
  • Handles multiple priorities.
  • Manages emotions and can make decision under pressure.
  • Manages stress appropriately.
  • Works alone effectively.
  • Works effectively in close proximity to others and/or in a distracting environment.
  • Works effectively with others /teamwork.
  • Understands and practices Universal Precaution.

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