Job Description

Excited about this role, but don’t meet 100% of the expected qualifications listed above? We’d still love for you to apply! Catholic Charities Serving Central Washington is committed to building a diverse and inclusive workforce where unique experiences are valued and everyone has the opportunity to contribute. Research has continuously shown that women and people of color are less likely to apply to jobs unless they meet all the listed qualifications. We want to help overcome this trend and seek to make space for unique and relevant skills and attributes. So, when applying to Catholic Charities Serving Central Washington, rest assured that your application is reviewed by a living, breathing human being, and evaluated based on key competencies needed for success in the position. Questions or concerns? Contact 

re********@ca*****************.org











, we’d be happy to connect!

You can do the work you love, be your authentic self, and make an impact in the lives of thousands. We believe in a culture rooted in community, collaboration, and growth. As an agency we are inspired by our Mission of bringing hope to life, especially those most in need.

Wage:

$75,000 – $95,000

Benefits

Medical, dental, life, flexible spending, EAP, retirement & vol benefits including vision, ltd, life insurance, critical illness, injury accident & ID theft protection. 13 paid holidays, 12 days of vacation, 8 sick days. Bereavement leave, education assistance program. Discretionary longevity award of 1.5% of annual salary starting after 5 years of service.

Position Summary:

The Clinical Utilization Manager is responsible for the continued development and oversight of effective systems to ensure the highest possible Standards of Care and Compliance for all Behavioral Health Treatment services provided by all sites. The Clinical Utilization Manager responds immediately to changing requirements in Medicaid, Health Care Authority, Beacon, or Managed Care Organization requirements. The position oversees ongoing record review to ensure appropriate access to services, length of care, and clinical documentation. The Clinical Utilization Manager arranges training for staff and educates on changes to behavioral health policies and procedures.

The Clinical Utilization Manager collaborates with the Director of Clinical Practice and Associate Directors to develop strategies to bring about improved clinical services and access to care.

This position is responsible for consistent onboarding of new clinicians and case managers to develop competency and full compliance with Care Logic documentation and standards of care. The Clinical Utilization Manager reports on productivity for psychiatrists, clinicians and any position providing direct clinical care. Productivity data is shared with clinical supervisors to ensure minimum standards are met.

Responsibilities:

Maintain continuous oversight of contracts, PHI, and clinical documentation.

• Maintain knowledge of behavioral health contracts and deliverables.
• Maintain knowledge of requirements within the current SERI (Service Encounter Reporting Instructions Federal and State) reporting instructions and ensure the best possible accuracy within the Electronic Health Record.
• Coordinate with the Client Service Manager to ensure clinical documentation is completed in a timely manner and coded appropriately for accurate encounter data.
• Immediately inform the Compliance Office and Director of Clinical Practice Director of any breach or suspected breach of Protected Health Information including notification and tracking.

Provide training to clinicians on SERI and EHR documentation.

• Ensure all new clinicians receive training on SERI and EHR documentation.
• Provide annual refreshers to clinicians on documentation procedures.
• Provide reports to supervisors on clinician status in completing documentation within 24 hours.
• Work with Client Service Manager on any corrective actions needed.
• Ensure provision of Federally required Medicaid Fraud and Abuse training annually and all staff demonstrate proficiency through the test on Relias.

Establish quarterly utilization management record reviews at all sites with cross system peer reviewers to enhance quality of care and training.

• Support sites and behavioral health programs in conducting both scheduled and spontaneous and random clinical encounters.
• Record reviews to ensure medical necessity is met, diagnosis and treatment plan incorporate assessment symptomology.
• Services provided are reflected on the treatment plan, evidenced based treatment is provided, and services are documented according to policies.
• Prepare results of Utilization Site Review, score results, analyze scored reports and establish corrective actions and with the Director of Clinical Practice to implement corrective strategies.
• Directly engage and train staff to understand reasons behind documentation and utilization review requirements.

Assist the Director of Clinical Practice, Associate Directors, and Compliance Officer in preparing for audits including Licensure Dept of Health audits, Managed Care Organization audits, and other governing entities.

• The Clinical Utilization Manager is present and involved in major audits and site visits.
• Work with Director of Clinical Practice and Associate Directors to prepare records and policies for audit.
• Work with Director of Clinical Practice and Compliance Officer to prepare written responses to corrective actions as needed, citing source documentation as appropriate, and submit the audit response in a timely manner.

Maintain quality utilization review oversight for all behavioral health services.

• Maintain effective Utilization Management processes and systems to ensure medical necessity for admission, continued treatment, and service closures comply with contractual, WAC, and agency behavioral health standards, policies and procedures.
• Work closely with Director of Clinical Practice and Associate Directors to build a clear understanding of the mutual dependency between clinical treatment teams and utilization review processes, which carry equal importance in provision of behavioral health treatment.
• Work with Director of Clinical Practice to provide access to behavioral health care in all sites, implementing innovative practices such as walk-in crisis, walk-in same day intakes, centralized scheduling. and other methods to expedite access to care.

Provide monthly or bi-monthly reports of clinician productivity to supervisors and clinicians.

• Work with EHR Technician to query, process, analyze data to develop individualized clinician productivity reports and team productivity reports.
• Work with Human Resources to present staff who met the productivity guidelines for bonuses.

Perform other duties as assigned.

Job Requirements:

The following requirements are those that are normally required for performance of this position. Any disabled applicant or incumbent who does not meet one or more of the requirements, but who can perform the essential function of the job (with or without reasonable accommodations) shall be deemed to meet these requirements.

Physical Requirements:

This position normally requires the physical demands of standing, walking, bending, lifting or performing other work requiring low physical exertion, talking and hearing and adequate vision on a regular basis to perform job requirements. These physical demands are required up to 90% of the time.

Non-Physical Requirements:

Education

• Masters degree in social work, or related field, and/or a Masters degree with a state designation of Mental Health Professional

Experience

• Three or more years experience in a progressively responsible Clinical and/or Behavioral Health Operations position

Special Skills

• Demonstrated experience with contract or project management
• Ability to comprehend and apply complex federal, state, local and contractual regulations as well as organizational requirements
• Knowledge of applicable laws and Medicaid requirements related to Behavioral Health, as well as related Washington Administrative Codes and other regulations
• Knowledge of quality improvement strategies, principles and practice approaches applicable to behavioral health
• Excellent organizational skills with the ability to communicate respectfully with the professional teams
• Committed to maintaining an optimistic, solution-focused and strength-based approach in all aspects with respect to those we serve as well as relationships with colleagues
• Computer experience with Microsoft Word, Excel, and EHRs
• Excellent written and oral communication skills
• Ability to work independently in addition to working as a member of a team
• Demonstrates the principles of Diversity, Equity and Inclusion established for the agency
• Support and uphold the mission, beliefs and values of Catholic Charities Serving Central Washington

Licenses, Registration, Or Certification:

• Preferred license as Social Worker, Mental Health Counselor, or Marriage and Family Therapist
• Required Dept. of Health Affiliated Counselor
• Valid Washington State Drivers License and required minimum liability insurance for WA State

Employment is conditional upon:

• Being cleared by criminal background check and fingerprinting when required.

How to Apply

Job Categories: Equal Opportunities. Job Types: Full-Time. Job Tags: Clinical Utilization, manager, outpatient, Washington state, and yakima. Salaries: Not Disclosed.

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