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The Position Alameda County Behavioral Health Care Services (ACBHCS) is actively recruiting for a full-time temporary Clinical Review Specialist. This position will be located in the Quality Assurance Unit. This position does not provide direct care services but may have contact with members of health plans that are the responsibility of ACBHCS. Clinical Review Specialists have extensive contact with the general public, providers, contractors and employees who provide clinical services. The expected duration of this temporary assignment is up to 18 months.
QUALITY ASSURANCE: The Clinical Review Specialist assesses quality of care and documentation; manages audits: internal/DMH/EPSDT; responds to provider questions about documentation standards, claiming, staff qualifications and other regulation based questions; revises and writes manuals, procedures etc.; works with other departments within Behavioral Health Care Services on QA related projects in meetings and work groups; investigates complaints; does provider training; works well in a team atmosphere; is proficient on PC and with the MS Office Suite of programs; monitors compliance with regulations including but not limited to: documentation, HIPAA, chart reviews/utilization review, grievance tracking/reporting, Change of Provider Requests, ensuring licensure is valid and in good standing, and performs other related duties as required.
The Department Alameda County Behavioral Health Care Services (BHCS) provides a full range of mental health and alcohol and other drugs services. Services are provided by county staff, private providers, and through contracts with community-based organizations to adults and older adults with serious mental illnesses (SMI), children with serious emotional disturbance (SED) and transition age youth with SMI or SED. Our network of services consists of over 400 individual practitioners, more than 90 community-based agencies, 20 hospitals and other organizations. Our county is geographically large and ethnically diverse. Services are available in several languages and are provided by multicultural and multidisciplinary providers, many of whom have developed specialties that meet the unique needs of our clients and families.
BHCS has funded MHSA programs that: increase consumer and family member access to culturally competent and wellness recovery/resiliency oriented services; support providers in their efforts to serve our populations using Wellness Recovery and Resiliency oriented strategies and supports; and increase the leadership presence of consumers and family members at all levels of our systems of care.
QUALIFICATIONS EDUCATION: Possession of a Master’s degree from an accredited college or university in Social Work, Marriage and Family Therapy, Psychiatric Nursing, with an emphasis in Clinical Social Work or equivalent degree which meets requirements set by California Board of Behavioral Sciences Marriage and Family License, or a Ph.D in clinical, counseling or educational psychology from an accredited college or university.
Note: Completion of an accredited nursing program, including three years of post-licensed nursing experience may be substituted for the Master’s degree in nursing.
EXPERIENCE: Three years of full-time, paid post-license or post registered experience in direct behavioral health care that includes treatment and disposition planning and/or the clinical review of these direct mental health care services.
LICENSE: Possession of a valid clinical license from the applicable licensing authority: California Board of Behavioral Sciences, California Board of Psychology, or California Board of Registered Nursing. Applicants must possess such license prior to appointment to such positions.
Some positions may require a valid California Motor Vehicle Operator’s license.
Special Requirements: In compliance with the Administrative Simplification provision of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), employees in this classification are required to possess a National Provider Identifier (NPI) number prior to their first day on the job.
In compliance with Medicare regulations, eligible licensed clinicians in this classification are required to complete the "Medicare Enrollment Process for Physicians and Non-Physician Practitioners" through the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services, prior to their first day on the job. Active enrollment in Medicare is a condition of employment. Failure to attain or maintain active enrollment will result in termination.