CRF – CELEBRATING 45 YEARS OF EXCELLENCE IN BEHAVIORAL HEALTH SERVICES IN SAN DIEGO COUNTY!

Hours: 36 hours per week; Monday - Thursday 8:30 am to 5:00 pm and Friday, 9:00 am - 1:00pm.
Pay Rate: $45.41 to $48.08, depending on experience
Education: Master’s degree in a mental health-related field, such as Psychology, Counseling or Social Work required
Licensure: Licensed Psychologist, Social Worker, Professional Clinical Counselor, or Marriage and Family Therapist is preferred. If unlicensed, must be a Board Registered or Waivered Clinician with clinical supervision hours complete or close to complete.
o Note for Internal CRF Applicants: QI supervisor is willing to work with the current CRF program to allow an individual to continue working at the program seeing clients 1 day per week (with 4 days per week at Central Office) on a temporary basis, to allow the individual enough time to finish collecting the client hours needed for licensure.

KNOWLEDGE AND EXPERIENCE:

• Required Knowledge: High-quality billing and documentation practices; Current mental health treatment modalities; Diagnostic and Statistical Manual classifications; Legal/Ethical requirements for mental health professionals; Medical Record documentation standards/requirements.
• Preferred Knowledge: MediCal documentation requirements for Specialty Mental Health Services; CRF and San Diego County protocols, especially regarding the medical record review and audit processes; Client Rights regarding service denial, client care and grievances.
• Experience working in a Quality Improvement Department or role is preferred.
• Experience working with individuals who have a serious mental illness preferred.
• Experience conducting clinical or documentation training is also preferred.

ADDITIONAL QUALIFICATIONS AND SKILLS REQUIREMENT

• Strong writing skills including attention to detail and editing.
• Ability to analyze complex information, understand/interpret policies and procedure and exercise independence judgement and initiative.
• Ability to compile/organize data and communicate and consult effectively with program management.
• Intermediate to advanced proficiency in MS Office applications, most importantly Word, Excel, and PowerPoint.
• Ability to pass criminal/background clearance

• Evaluate client medical records for CRF programs to ensure accurate and complete documentation of medical necessity, treatment modalities, risk assessment, and appropriate level of care. Ensure documentation meets medical necessity for billing specialty mental health services to MediCal as well as evidences a high quality of care provided to CRF clients.
• Compare medical record documentation with professional standards of care and County/State/Federal regulations.
• Provide feedback, education, and training to program management and direct care staff regarding accurate/compliant billing and quality documentation practices.
• Provide formal and ongoing Quality Documentation Trainings to program managers and clinical/direct care staff.
• Conduct investigations of fraud, waste, and abuse. Discuss discrepancies in documentation of services with appropriate clinical and administrative staff and recommend actions to resolve issues.
• Determine if program documentation meets medical necessity using professional judgment and established criteria and make recommendations for disallowance and billing corrections as needed.
• Support CRF programs during annual County Quality Performance Reviews (formerly known as Medical Record Reviews).
• Provide results, reports/dashboards, and feedback to CRF Senior Management Team and program staff. Develop corrective measures and process improvement plans to address any problematic documentation and billing themes at CRF programs.
• Run and analyze reports from the designated electronic health record to correct and prevent billing disallowance and errors.
• Continuous monitoring of adherence to MediCal, DHCS, CCL, County, State, Federal and other regulatory standards.
• Perform other quality improvement and assurance duties as assigned by the supervisor.