Job description
Job Summary:
The Behavioral Health Quality Reviewer conducts and coordinates quality review activities for behavioral health services. Provides clinical review, educational, consulting, and coordinating support to assigned areas. Coordinates with physicians, staff, and non-Kaiser providers and facilities regarding assessment of clinical care paths. In conjunction with physicians, monitors all clinical activities, makes recommendations, identifies cost-effective protocols, and develops guidelines for care.
Essential Responsibilities:
- Performs concurrent review of ambulatory service records based on care standards and the level of care (LOC) needed (long term vs short term management plans):
- Review medication plan with primary diagnosis, coordination of medication plan between primary care and behavioral health practitioners.
- Review appropriate follow-up visits according to treatment plan, documentation and coordination of referral to internal and, external resources and transition plans in accordance with closure of the treatment plan.
- Review case notes are timely and reflect adequate time to reach goals outlined in the plan of care and the level of care need.
- Review the intake includes a thorough and accurate assessment for: suicide, homicide, abuse and appropriate legal reporting completion is documented.
- Review initial and follow-up appointments are appropriate to patients condition and treatment plan.
- Performs concurrent review of mental health assessments, diagnosis, treatment and crisis intervention services for members.
- Provides objective assessment of important aspects of patient care through ongoing chart review with pre-established criteria.
- Collaborates with treating physician, psychiatric and allied health professional team to assess each individual members treatment program.
- Collaborates with psychiatrists, allied health professionals, and other specialty care providers on psychological and neuropsychological plans of care.
- Reviews members treatment and progress in accord with state and NCQA regulations and in keeping with accepted community standards.
- Reports all occurrences which may lead to medical center liability and follows up as necessary.
- Facilitates interdisciplinary collaboration for implementation of evidence based guidelines, criteria and other clinical tools to reduce variation in clinical practice and to optimize clinical outcomes.
- Applies the appropriate performance improvement methodology to address improvement opportunity.
- Educates physicians and staff regarding regulatory reviews, i.e. the interpretation of regulatory requirements and the methods of compliance when preparing for a review or the interpretation of project goals.
- Supports the regional and medical centers continuous survey readiness program to maintain compliance with regulatory standards.
- Conducts quality management studies through data collection, data input and report development and analyzes, interprets and provides recommendation based on quality principles.
- Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
- Develops and maintains relationships and effective communication with all levels of medical center physicians and staff in order to facilitate problem identification and resolution.
- Determines strategy for changing existing processes to meet regulatory requirements and translating external demands into program goals.
- Design and develop reports; track all work via tracking logs or other databases.
Basic Qualifications:
Experience
- Minimum three (3) years in assessing, diagnosing and treating a broad range of psychiatric conditions.
Education
- Masters degree in Social Work or other Behavioral Health related field required from an accredited college or university required.
License, Certification, Registration
- Registered Nurse License (California) OR Licensed Marriage and Family Therapist (California) OR Licensed Clinical Social Worker (California) OR Psychologist License (California)
Additional Requirements:
Knowledge of social service agencies, state regulations and APA standards as it related to client treatment, patient rights and client/patient confidentiality.- Previous clinical responsibilities to include behavioral health, diagnosis, crisis intervention, brief individual and group psychotherapy.
- Knowledge of psychological testing techniques, administration and interpretation.
- Excellent interpersonal and communication skills.
- Demonstrated subject matter expertise in behavioral health care delivery.
- Demonstrated ability to achieve results through influence and collaboration.
- Demonstrated ability to conduct and interpret quantitative/qualitative information with analytical problem solving and project management.
- Must demonstrate an understanding of any applicable regulations related to the responsible technical area.
- Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
- Mastery of computer software, Word, Excel, Access database, Powerpoint, etc.
- PhD, PsyD, EdD, Nurse Psychiatric Practitioner or Psychiatric Clinical Specialist in clinical or counseling from an accredited college or university.
PrimaryLocation : California,Fontana,Palm Court II - SCAL Regional
HoursPerWeek : 40
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri
WorkingHoursStart : 08:00 AM
WorkingHoursEnd : 05:00 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : NUE-SCAL-01|NUE|Non Union Employee
Job Level : Individual Contributor
Job Category : Behavioral Health, Social Services & Spiritual Care
Department : REGIONAL PALM COURT II - Mental Health/Psych-Integ Svcs - 0806
Travel : Yes, 20 % of the Time
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.
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