Alameda County Behavioral Health is recruiting to fill several
CLINICAL REVIEW SPECIALIST positions* with the Utilization Management Department.
$102,258-$120,549 Annually
Plus, an excellent benefits package!
*Provisional Appointments: For provisional appointments, a civil service exam is not required. However, to obtain a permanent position, the appointee will need to compete successfully in a County Exam when open.
HEALTH CARE SERVICES AGENCY serves over 1.6 million residents and covers 14 cities and 6 unincorporated communities.
Behavioral Health Care Services (BHCS) is one of four distinct departments embedded within HCSA. BHCS is dedicated to delivering cost effective, quality behavioral health care to Medi-Cal beneficiaries and residents of Alameda County. These behavioral health care services include Alcohol and other Drug and Mental Health services.
UTILIZATION MANAGEMENT
The Utilization Management (UM) Program includes oversight of behavioral health care services from a utilization perspective, including coordinated review assessment performed to determine the medical necessity and appropriateness of behavioral health care services. The UM Program encompasses inpatient and specialty mental health care services rendered to all Alameda County Medi-Cal beneficiaries and all other services provided directly by ACBH or indirectly through contractual agreements with ACBH.
The POSITION
Under general direction, to provide behavioral care services by telephone, face-to-face, and/or record review for referral, treatment, and/or payment authorization and service integration; to gather and analyze case history data and treatment plans; to make treatment recommendations and to assess quality of care; to record all findings and maintain review records; and to do related work as required. Clinical Review Specialist (CRS) positions are located in ACBH’s ACCESS Program, Quality Assurance and Utilization Management Program. These positions provide a variety of clinical services including screenings and referrals, face to face assessments, review of medical necessity for authorization of services, utilization review, assessment of quality of care, and provider consultation.
Please CLICK HERE for a comprehensive Clinical Review Specialist job description and additional requirements.
Utilization Management is currently recruiting three (3) provisional CRS’. Below are some of the major tasks, duties and responsibilities of the CRS’ in the UM Program:
- Develops, maintains, and appropriately applies knowledge of applicable Federal and California regulations and County policies, and Medi-Cal Specialty Mental Health Services (SMHS) medical necessity criteria for service and payment authorization.
- Develops and maintains a working knowledge of the array of current resources in the ACBHC System of Care (SOC), specifically the Adult and Older Adult SOC and the Children and Young Adult SOC.
- Provides case consultation and review to determine medical necessity and appropriate utilization of system resources for both hospital and non-hospital services; assesses level of care, treatment and disposition plans, and documentation.
- Obtains, receives, and utilizes required information and documentation, which may include provider site visits, to conduct prospective, concurrent, and retrospective review for authorization requests; makes determinations of appropriateness of placement and aftercare plans.
- Makes denial recommendations and identifies quality concerns to the UM Physician; engages in interactive case consultations with UM Physician and community providers.
Click above for comprehensive job description, additional requirements and benefits information.
MINIMUM 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 the California Board of Behavioral Sciences;
-OR-
A Ph.D. in clinical, counseling, or educational psychology from an accredited college or university.
AND EXPERIENCE: The equivalent of three years of full-time, paid post-license experience in direct behavioral health care that includes treatment and disposition planning and/or the clinical review of these direct mental health and substance use disorder services.
LICENSES/CERTIFICATIONS: 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.
HOW TO APPLY
An Alameda County Application is required to be considered for this recruitment.
Please email the County of Job Application and a cover letter to:
Juliene Schrick ([email protected])
The application template is available online on Alameda County’s On‐Line Employment Center at
NEW USERS can click on “New User Registration” to fill out an application template. Once the application is completed, please click on the “Review” tab to “Print/Save My Application”. A PDF version or digital scan of the application must be submitted to the email address above.
Alameda County Health Care Services Agency is enriched with a diverse workforce. We believe the best way to deliver optimal programs and services to our communities is to hire and promote talents that are representative of the communities we serve. Diverse candidates are strongly encouraged to apply.
Organization Details
