Quality Care Management Coordinator

About the role

The County of Santa Barbara Behavioral Wellness Department is accepting applications to fill one (1) full-time Quality Care Management (QCM) Coordinator vacancy. This position may be based at any County work location within Santa Barbara County. The selected candidate will be required to travel between Santa Barbara, Santa Maria, and Lompoc as part of their regular duties. The role offers some flexibility for hybrid remote work, subject to departmental and position needs.

Responsibilities

• Develops and implements policies and procedures for the quality improvement 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;
• Authorizes reimbursement of contracted inpatient and outpatient 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;
• Prepares correspondence using word processing software;
• Reviews state regulations; reviews policies and procedures and makes recommendations to management on methods to conform to regulations;
• Meets regularly with care providers to identify and address quality improvement issues;
• Conducts training sessions for clinical and support staff on documentation.

Requirements

• Three years of clinical experience as a licensed mental health professional as defined by California Code of Regulations, Title 9, Chapter 11,1770 (including registered nurses, licensed clinical social workers, and marriage and family therapists).
• 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 9, Chapter 11,1770 and 1820.200. Work must have included some experience planning, organizing, and evaluating program operations and staff.
• 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.

Qualifications

• 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.

Skills

• 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 and/or education in alcohol and other drug services.
• Detail oriented while handling multiple projects with competing priorities.
• Processes, interprets and communicates complex contractual information to internal and external clients.
• Open to change and new information and ability to adapt behavior and work methods in response to new information, changing conditions, and unexpected obstacles.

Benefits

• Bilingual skills in English/Spanish are highly desirable but not required.

Pay

Details on pay will be provided in the job offer letter.

Schedule

Details on schedule will be provided in the job offer letter.