Bh/Ds Clinician III

The City of Virginia Beach Department of Human Services is seeking a talented Clinician III to fill the Utilization Review Specialist vacancy operated within the Children's Services Act (CSA) office primarily and the Office of Program Support (OPS). This position is responsible for collaborating with the Family Assessment Planning Teams (FAPT) and the CSA Administrator to implement the local utilization management plan also known as the Continuous Quality Improvement (CQI) plan to evaluate the quality and appropriateness of intensive treatment services purchased for youth and families served through the Children's Services Act (CSA) Office.

Specific Job Duties:

• Review provider treatment plans and progress reports to ensure they support the child's Individualized Family Service Plan (IFSP), Child and Adolescent Needs and Strengths (CANS) Assessment, mental health diagnosis and discharge plan and reflect the progress of the child and the interventions by the facility's staff and treatment team.

• Utilize CANS data in CANVaS system to track changes in an individual child's CANS scores as a result of treatment services provided.

• Review medical, behavioral, and clinical documentation in files to ensure that the child is receiving high quality and appropriate services in compliance with the CSA Vendor contract and all federal, state, and local regulations. Ensure all medications are prescribed and documented accurately and in accordance with all licensing regulations as well as federal, state, and local policies.

• Support the CSA Administrator in adhering to the Code of Virginia, requiring the CSA office to collect, review, and analyze aggregate CSA data and assist with the development of long-range program planning.

• Use various electronic health record/records management systems to provide utilization review for the office of Children's Services Act

• Inspect charts for documentation of family participation to include method, frequency and progress towards discharge goals.

• Conduct site reviews of contracted facilities to include interviews with members of the child's treatment team and privately with the child to evaluate the services, environment, client's view, level of family engagement and progress towards discharge.

• Collaborate with FAPT and CSA Administrator to review the information received from Provider evaluations and follows up on complaints or issues.

• Support the OPS in management of vendor contracts and licensing regulations, and knowledge of purchased services and interventions.

• Attend Community Policy & Management Team meetings and presents before the team.

• Compile statistical data and at times collaborate with representatives from CQI.

• Monitors recommended funding sources to ensure CSA maximizes the use of alternative funding streams when appropriate and Providers remain in compliance with DMAS requirements.

• Collect, track, review, and manage all DMAS/Medicaid authorizations and denials.

• Identify cases that are appropriate for Intensive Care Coordination (ICC) while youth is in congregate care and collaborates with FAPT and the case manager to discuss the use of ICC services for those at risk of out home placements.

• Track and monitor the utilization of Intensive Care Coordination (ICC) services and prepares utilization and outcome reports to the CPMT

• Conduct site visits of new providers who are being considered for the Virginia Beach CSA Provider Network prior to contract approval.

• Conduct case conferences as needed to assist case managers outside of FAPT to secure quality services best matched to their client's needs.

• Assist with identifying the gaps in services and identifying new resources to meet these gaps in client needs.

• May perform clinical functions to support quality control system to improve CSA services.

• Assist with Human Services related federal, state, and/or local audits.

• Active participation in corrective action plans and quality control activities that support desired outcomes.

• Research and utilize regulatory manuals, provider manuals, local policy and state guidelines to provide guidance to all CSA stakeholders.

• Assist parent self-referrals for information and services as needed.

• Adhere to federal, state, and local policies associated with CSA.