BWELL Quality Care Management Coordinator

Description SALARY: $. - $. Hourly$,. - $,. Annually 

The County of Santa Barbara Behavioral Wellness Department is accepting applications to fill one () full-time  Quality Care Management (QCM) Coordinator vacancy. The selected candidate may need to travel between different operational sites within Santa Barbara County that includes Santa Barbara, Santa Maria, and Lompoc . Separate lists for different locations will not be established. Therefore, you must check Santa Barbara, Santa Maria, and Lompoc  on the application and must be willing to work in all of these locations. Quality Care Management (QCM) Coordinator is the working title for this position and encompasses the concept that the incumbent will work performing the duties of a Quality Assurance Coordinator. The County job classification associated with this title is Quality Assurance Coordinator. 
 
We are also establishing one employment list to fill future full-time, part-time, and extra-help (temporary) and * vacancies.
 
* vacancies may occur as a result of a leave of absence (Civil Service Rule ) and the duration of the appointment shall be subject to the return of the individual who is on leave. A person who is appointed to a position under Civil Service Rule may  be able to transition into a regular position in the classification without re-application or re-testing, depending on the performance of the appointee and the needs of the department.

THE POSITION :
 
This position works within the Quality Care Management division of the Behavioral Wellness Department. The Quality Care Management Coordinator reports to the Quality Care Management Program Manager. Under general direction, the selected incumbent will conduct and coordinate quality improvement and utilization review activities of mental health and alcohol and other drug services for the Department of Behavioral Wellness and for contracted providers; and performs related duties as required. 
 
Incumbents in this class work in a system of interdisciplinary departmental teams and/or contract service agencies providing assessment, prevention, intervention, treatment, and related ancillary support services via an integrated service delivery system to people with alcohol and other drug related problems, mental illness, and/or co-occurring conditions. 
 
The work schedule for this position will depend upon the needs of the Department.
 
ABOUT THE DEPARTMENT:   

The County of Santa Barbara's Department of Behavioral Wellness isresponsible for ensuring the provision of mental health services mandated by the State of California for children with serious emotional disturbance, adults with serious mental illness, and all Medi-Cal beneficiaries with specialty mental health needs. Behavioral Wellness also provides substance use disorder treatment services for Medi-Cal beneficiaries. Our Mission is to promote the prevention of and recovery from addiction and mental illness among individuals; families and communities by providing effective leadership and delivering state-of-the-art, culturally competent services that are guided by measurable client-specific outcomes. Behavioral Wellness annually provides treatment, rehabilitation and support services to approximately , clients (, children/adolescents and , adults) with mental illness and , clients with substance use disorders. For more information, please visit:
 

The Ideal Candidate  will: Knowledge of California Mental Health Plan and Drug Medi-Cal Organized Delivery Systems including recently enacted laws tied to the Managed Care Final Rule and Drug Medi-Cal Organized Delivery System.  Demonstrated ability to develop and maintain sound working relationships with people of diverse backgrounds and personalities.  Experience in clinical and/or managed care planning and oversight.  Strong background as a licensed mental health professional.  Experience managing and monitoring regulations.  Experience in utilization review.  Experience and/or education in alcohol and other drug services.  Excellent oral and written communication skills and the ability to interact with all levels of internal and external customers.  Detail oriented while handling multiple projects with competing priorities.  Organized and prioritize work, and meet deadlines.  Processes, interprets and communicates complex contractual information to internal and external clients.  Open to change and new information, and adapt behavior and work methods in response to new information, changing conditions, and unexpected obstacles.  Bilingual skills in English/Spanish is highly desirable, but not required. Examples of Duties Develops and implements policies and procedures for the utilization review function to assure the effective utilization of medical or psychiatric services, and appropriate service reimbursement; reviews requests for authorization of services to determine whether the diagnosis and proposed treatment fall within the criteria for service reimbursement and authorizes treatment or refers the request to a higher medical authority; and authorizes reimbursement of contracted inpatient and outpatient services. Collects and reviews statistics of services provided using automated systems to determine effectiveness and quality of care provided and to assess whether changes in the program are necessary to provide optimum health or psychiatric care in the most cost-effective manner; and generates reports from automated system. Works with beneficiaries, providers, co-workers, and other public agencies to discuss or explain services provided or denied, give direction or authorization for specialized treatments, and establish eligibility of beneficiaries for services. Collaborates with fiscal intermediaries, medical staff or mental health professionals, and others to review and interpret patient records and documentation when requests/claims for reimbursements are denied; writes narrative and statistical reports on utilization reviews; and prepares correspondence using word processing software. Reviews state regulations; reviews policies and procedures and makes recommendations to management on methods to conform to regulations; educates staff on regulation changes; meets regularly with care providers to identify and address utilization review issues; and conducts training sessions for clinical and support staff on utilization review and documentation. Assigns, reviews, and evaluates the work of professional, technical, and clerical staff. Employment Standards

Applicants must meet the employment standards (minimum qualifications) list below to be considered for this position. Detailed information should be included in the application.

Three () years  of clinical experience as a licensed mental health professional as defined by California Code of Regulations, Title , Chapter , § (including registered nurses, licensed clinical social workers, and marriage and family therapists). Work must have included some experience planning, organizing, and evaluating program operations and staff; OR , Three () years  of clinical experience as an ASW or MFT intern or other waivered/registered Point of Authorization staff as defined by California Code of Regulations, Title , Chapter , § and .. Work must have included some experience planning, organizing, and evaluating program operations and staff; OR , A combination of training, education, experience, and licensure or registration that is equivalent to one of the employment standards listed above and that provides the required knowledge and abilities. Professional Licensure: Where licensure is required, applicants must possess licensure in their profession at the time of application. Initial appointment may be based upon comparable licensure in any state; however, California licensure is required within two years of appointment as a condition of continued employment.

Additional Requirements: This position requires travel within the County on a weekly basis. A valid driver’s license is required at the time of application. A valid California Class C Driver’s License is required at the time of appointment.

Knowledge of: State regulations applicable to treatment and reimbursement under Medi-Cal and other third party payers; basic utilization review procedures and techniques; medical and surgical, mental health, or alcohol and drug diagnoses, procedures, and types of treatment; basic principles and practices of supervision; and English grammar and usage.

Ability to : Prepare and maintain accurate records; interpret rules and regulations; read and understand patient records; work tactfully and effectively with staff, patients, families, fiscal intermediaries, and providers; prepare clear and concise reports using correct grammar, punctuation, and spelling; maintain objectivity and confidentiality; gather and analyze data, draw conclusions, and make recommendations; communicate effectively, both one on one and in groups; and use word processing, spreadsheet, and database applications on personal computer.

---