Job Summary:
In addition to the responsibilities listed below, this position is also responsible for reviewing services (e.g., mental health assessments, treatments, crisis interventions) and documentation to ensure quality, accuracy, and completeness; conducting a clinical review of moderately complex treatment plans and follow-up care to ensure appropriateness and alignment with best practices and internal and external guidelines; leveraging guidelines and tools to provide direction on appropriate behavioral health interventions and care plans as well as documentation of care provided; reviewing intakes, follow-up visits, and/or progress updates to ensure each entry has a complete and accurate assessment of mental health risk (e.g., suicide, abuse) and that appropriate procedures and processes are followed; educating physicians and allied health professionals to ensure understanding of regulatory requirements and align on behavioral health care plans; and independently conducting quality management studies through data collection, analysis, and synthesis to identify areas for program improvements and assess risks.
Essential Responsibilities:
Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome.
Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and/or externally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities and deadlines. Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions.
Ensures quality of care by: using advanced knowledge to review moderately complex patient assessments, care, and interventions for completeness and accuracy; prioritizing patient experience during internal and external care transitions by proactively anticipating and identifying barriers; documenting the progression of treatment plans and conducting moderately complex chart reviews; contributing critical updates during multi-disciplinary clinical consultation meetings to discuss patient treatment; and coordinating patient care needs (e.g., coordinating transfers, planning discharges, making community service referrals, reviewing and/or obtaining authorizations) as they move across the continuum of care.
Manages patient data and records by: compiling and reporting patient information and data (e.g., length of stay, services provided, cost) and facilitating interventions as necessary; and conducting quality management studies and/or audits through data collection, data input, and report development and collaborating with stakeholders to improve future practices.
Coordinates the care of a moderate caseload of patients by: collaborating with treating clinician to review and ensure quality of patient treatment plans; advising, guiding, and/or coordinating services to improve care coordination based on quality principles; using advanced knowledge to recommend patient referrals for moderately complex cases; developing and maintaining case management policies and procedures to ensure optimal and appropriate member utilization and engagement of services; and solving problems concerning patient treatment plans and follow-up appointment documentation.
Ensures member compliance with policies and procedures by: solving compliance failures to promote patient care and avoid liability concerns; applying local, state, and federal standards, regulations, credentialing organizations requirements, health plan benefits, policies, and procedures when working with patients, physicians, medical office staff, contact providers, and outside agencies; and leading efforts to support the survey readiness program at contracted facilities and/or medical centers to maintain compliance with regulatory standards.
Collaborates with stakeholders to facilitate care by: cultivating relationships with external providers, medical center physicians, and/or other staff to solve patient treatment problems collaboratively and ensure contract compliance; and establishing relationships with outside contractors as well as serving as a liaison on contracting consultation including informing and advising on the organizations levels of care and referral process.
Minimum Qualifications:
Minimum five (5) years of experience assessing, diagnosing, and treating a broad range of behavioral health conditions.
Minimum three (3) years of experience in behavioral health case management or care coordination.
Masters degree in Psychology, Counseling, Social Work, or a related field AND minimum five (5) years of experience in counseling, social work, or a directly related field.
National Provider Identifier required at hire
Additional Requirements:
Knowledge, Skills, and Abilities (KSAs): N/A
COMPANY: KAISER
TITLE: Behavioral Health Quality and Utilization Review Consultant I
LOCATION: Rancho Cordova, California
REQNUMBER: 1395079
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
