Utilization Review Specialist

6 days ago

Fort Worth, Texas, United States ACH Child and Family Services Full time
Job Summary

The Utilization Review Specialist - Residential Services will play a critical role in ensuring that youth receive the most appropriate level of residential services for their well-being and to achieve permanency. This position will be responsible for coordinating and managing all utilization review tasks for ACH Child and Family Services related to placement with or between Network Providers.

Key Responsibilities
  • Coordinates and/or participates in meetings with collaborating partners and agencies as assigned.
  • Participates in other administrative and planning meetings as needed to facilitate referral and placement.
  • Initiates and facilitates step-down and other utilization related meetings.
  • Coordinates and manages all utilization review tasks for ACH Child and Family Services related to placement with or between Network Providers.
Implementation
  • Receives and reviews client information from ACH Child and Family Services, DFPS, Network Providers, and other agencies to ensure the appropriate utilization of services to youth placed in an ACH Child and Family Services Network Provider.
  • Reviews and responds to all 3rd party level of care utilization reviews to ensure that ACH Child and Family Services youth are receiving appropriate services based on their needs. Will track Network Provider progress.
  • Responsible for ensuring that exceptional services are negotiated, secured, reviewed, approved, and implemented, with all deadlines met.
  • Ensures services adhere to applicable ACH Child and Family Services policy and procedures and other Contract outcomes.
  • Maintains an up-to-date listing of all Agency network providers and services.
  • Ensures youth are placed in properly trained and licensed facilities with appropriate capacity to provide services.
  • May participate in crisis calls as they relate to provision of services.
  • Requests documentation to ensure psychological and/or psychiatric services are provided as needed when performing utilization reviews.
  • Tracks length of stay for youth placed with ACH Child and Family Services and ensure that youth are stepping down and achieving permanency.
  • Complete Utilization Review for clients in residential facilities as necessary.
  • Reviews documentation provided for youth's Service Planning as needed to review utilization.
  • Reviews child assessment tools as needed to ensure proper utilization of services.
  • Ensure quantified and measurable data is used during the child assessment phase to make appropriate decisions regarding the type and level of placement for the child and for the purpose of identifying needed family services.
  • Ensures youth placed in higher level settings are properly placed and stepped down to a less restrictive setting in accordance with treatment goals and length of stay compliance.
  • Promotes safety and encourages the least-restrictive and shortest length of out-of-home placement for children.
  • Reviews provider documentation and conducts on-site inspections to determine that services outlined in rate agreements are being implemented.
  • Ensures contract outcome measures are met with emphasis on utilization management.
  • Refrains from assuming any duty that is unrelated to and/or interferes with the responsibilities of the position.
  • Advocates, promotes, and practices cultural sensitivity and responsiveness in all day-to-day interactions.
  • Develops, promotes, and practices teamwork in all activities.
  • Completes other duties as assigned.
Training
  • Attends relevant in-service training offered at ACH Child and Family Services to expand knowledge of services and the application of clinical skills.
  • Attends mandatory training such as, but not limited to, Emergency Behavior Intervention, CPR and First Aid, Psychotropic Medications and Trauma-Informed Care training.
  • Communicates regularly with Therapeutic Services Manager and seek supervision when appropriate.
  • Attends continuing education necessary to expand knowledge and maintain certifications or licenses.
  • Notifies supervisor properly when absent.
  • Ensures that all deadlines are met and decisions affecting ACH Child and Family Services payments are communicated.
  • Establishes effective working relationships with co-workers.
  • Deals satisfactorily with and acknowledges work-related stress.
  • Maintains appropriate boundaries between professional and personal issues.
  • Adheres to all policies and procedures of ACH Child and Family Services and its accrediting and standard setting bodies, such as Council on Accreditation (COA) and state licensing.
  • Respects the dignity and worth of all clients and families.
  • Maintains client confidentiality per agency standards and all applicable codes of ethics.
  • Uses outside professional collaboration and intra-agency teamwork appropriate to the agency.
  • Learns, understands, and supports the agency's mission, purpose, and function.
  • Is prepared to address appropriate issues during supervisory conferences and meetings.
  • Accepts direction from supervisor and implements supervisor's suggestions and instructions.
  • Understands the job description in relation to other agency positions.
  • Continues to work to improve skills needed for position held.
  • Considers the environmental, cultural, safety, diversity issues and needs of the clients.

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