Utilization Review Clinician
(Part-Time) Reporting to the Clinical Manager, the Utilization Review Clinician is responsible for implementing and maintaining Utilization Management and its philosophy in their area of operation and influence. The Utilization Review Clinician functions as part of the multidisciplinary treatment team and has the responsibility to assist the team in appropriate access and use of internal and external resources.
- Perform both internal and external record reviews as part of daily department operations.
- Cooperates with Admissions to complete certifications as needed and documents outcome in certification record.
- Performs concurrent utilization review with insurance companies and relevant payers, documenting outcome of same in the certification record.
- Obtains and documents authorization for services not covered under per diems and communicates directly to physicians/clinician.
- Maintains an appropriate and ethical performance of reviews, both internal and external.
- Develop and maintain professional relationships with treatment team members to enhance the role of Utilization Management within the organization.
- Communicates to appropriate members of the treatment team the status of the cases assigned with mandatory reporting to the physician or team designee.
- Communicates need for Peer Reviews between physician and payers, facilitating as needed; completes documentation.
- Attends team/staff meetings per program scheduling, as clinically indicated.
- Assist in preparedness for surveys by regulatory agencies and payers.
- Audits/reviews charts-depth and intensity to be determined by data collection reports.
- AMFT or ACSW with current California Board of Behavioral Sciences (BBS) Registration required.
- Evidenced Based Trained/Certified in MAP, TF-CBT, SS Preferred
- Preferred strong clinical foundation, EMR experience, knowledge of Drug Medi-Cal expectations towards clinical documentation, case management experience related to community linkages for mental health, medical and housing services
- Assessment, Individual Counseling, Group Process, Family Counseling, Vocational Readiness, Social/Recreational Activities, Life Skills Training, Discharge Planning, Recovery Support Services,
- Ability and willingness to report to work on time and ready for work on each scheduled day.
- Ability to work in a fast-paced environment and to make decisions independently and communicate effectively when dealing with clients, families, other staff members, department heads, visitors, external agencies and community members.
- Ability to effectively communicate verbally and in writing with appropriate documentation skills to complete reports, utilize data and communicate ideas constructively.
- Ability to establish and consistently enforce appropriate boundaries with client/patients of Phoenix House.
- Strong crisis management, conflict resolution and de-escalation skills.
- Must show aptitude for working as part of a team.
- Must maintain a valid CA Drivers' License, have proof of automobile insurance and maintain a safe driving record based on Phoenix House policy.
Job Location: Venice, CA
Job ID: 92