BEHAVIORAL HEALTH UTILIZATION REVIEW SPECIALIST

santacruzcountyca.gov; Santa Cruz (CA); Híbrido; USD 70 000 - 110 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Annual Leave

Holidays

Medical Plan

Dental Plan

Vision Plan

Retirement

Life Insurance

Disability Insurance

Dependent Care Plan

H-Care Plan

Health Care FSA

Deferred Compensation

Resumo da oferta

County of Santa Cruz seeks a Behavioral Health Utilization Review Specialist to monitor the Mental Health Plan and DMC-ODS, review medical records, and support in ensuring quality care for clients receiving behavioral health treatment. The role involves interpreting regulations, training staff, advocating for quality treatment practices with Medi-Cal providers, and assisting in audit preparation.

A master’s degree in a related field is required, with licensure as a clinical social worker, LMFT,

Qualificações

• Knowledge: Thorough knowledge of psychological and social aspects and characteristics of emotional disturbances and mental illness; principles and methods of counseling and the accepted techniques for assessing psycho-social behavior for specialty mental health and/or substance use treatment clienteles.
• Working knowledge of human behavior, development and functional impairment; appropriate and available community resources; problems, needs and attitudes of those with substance use, emotionally ill and socially disturbed challenges; pertinent laws and regulations regarding health and social service programs; federal, state and county regulations pertaining to managed care; laws and regulations as they pertain to clients' legal rights, including privacy; pharmacology of medications and psychotropic drug treatment; methods and procedures of admissions, discharges and patient care in acute care psychiatric facilities.

Responsabilidades

• Under general supervision, support in monitoring the Mental Health Plan and DMC-ODS, including review of medical records to ensure proper utilization of treatment resources and quality of care for clients receiving behavioral health treatment.
• Interpreting, advising and training staff on federal, state and county regulations; addressing client concerns; advocating for quality client treatment practices with all Medi-Cal providers; supporting audit preparation for Behavioral Health; performing other duties as required.

Formação académica

Master’s degree with a major in Social Work, Psychology, Psychiatric Nursing, Marriage and Family Therapy, or a closely related science field

Descrição da oferta de emprego

EQUAL OPPORTUNITY EMPLOYER

County Equity Statement

Equity in action in Santa Cruz County is a transformative process that embraces individuals of every status, providing unwavering support, dignity, and compassion.

Through this commitment, the County ensures intentional opportunities and access, fostering an environment where everyone can thrive and belong.

THE JOB:

Under general supervision, support in monitoring the Mental Health Plan and Drug-Medi-Cal Organized Delivery System (DMC-ODS), including review of medical records to ensure proper utilization of treatment resources and quality of care for clients receiving behavioral health treatment. UR Specialists also interpret, advise and train staff on federal, state and county regulations, address client concerns, advocate for quality client treatment practices with all Medi-Cal providers, support in audit preparation for Behavioral Health and perform other duties as required. The ideal candidate will have electronic health record implementation and training experience. The list established will be used to fill the current and future vacancies during the life of the eligible list.

The option for hybrid remote work may be available based on the type of work and operational needs, upon successful completion of probation.

THE REQUIREMENTS:

Any combination of education and experience, which would provide the required knowledge and abilities, is qualifying, unless otherwise specified. A typical way to obtain the knowledge and abilities would be: Possession of a master’s degree with a major in Social Work, Psychology, Psychiatric Nursing, Marriage and Family Therapy, Registered Nursing or a closely related science field which has

Encouraged to Apply

BEHAVIORAL HEALTH UTILIZATION

SPECIAL REQUIREMENTS:

License, Registration: Possession of a license as a Clinical Social Worker, Marriage and Family Therapist (LMFT), Clinical Psychologist, or Registered Nurse.

Background Investigation: Fingerprinting is required.

Knowledge: Thorough knowledge of psychological and social aspects and characteristics of emotional disturbances and mental illness; principles and methods of counseling and the accepted techniques for assessing psycho-social behavior for specialty mental health and/or substance use treatment clienteles.Working knowledge of human behavior, development and functional impairment; appropriate and available community resources; problems, needs and attitudes of those with substance use, emotionally ill and socially disturbed challenges; pertinent laws and regulations regarding health and social service programs;federal, state and county regulations pertaining to managed care; laws and regulations as they pertain to clients' legal rights, including privacy; pharmacology of medications and psychotropic drug treatment;methods and procedures of admissions, discharges and patient care in acute care psychiatric facilities.

Ability to: Communicate effectively in oral and written format; establish and maintain effective interpersonal relationships; design and facilitate productive trainings and meetings; work independently; understand and apply state, federal and local regulations and laws governing quality assurance and utilization review;analyze behavioral health treatment documentation, including assessments, care plans and progress notes, for regulation oversight; use good judgment in order to make critical decisions about the medical necessity of treatment; promote a trauma-informed improvement culture; work within a high compliance-driven environment.

THE EXAMINATION:

Your application and supplemental questionnaire will be reviewed to determine if you have met the education, experience, training and/or licensing requirements as stated in the job announcement. If you meet these criteria and are one of the best qualified, you may be required to compete in any combination of written, oral and/or performance examinations or a competitive evaluation of training and experience as described on your application and supplemental questionnaire. You must pass all components of the examination to be placed on the eligible list. The examination may be eliminated if there are ten or fewer qualified applicants. If the eligible list is established without the administration of the announced examination, the life of the eligible list will be six months, and your overall score will be based upon an evaluation of your application and supplemental questionnaire. If during those six months it is necessary to administer another examination for this job class, you will be invited to take the examination to remain on the eligible list.

Women, people of color, and people with disabilities are encouraged to apply. If you have a disability that requires test accommodation, please call [phone].

To comply with the 1986 Immigration Reform and Control Act, Santa Cruz County verifies that all new employees are either U.S. citizens or persons authorized to work in the U.S.

Some positions may require Fingerprinting and/or Background Investigation.

Closing Date: Friday, November 6, 2026

BEHAVIORAL HEALTH UTILIZATION REVIEW SPECIALIST - SUPPLEMENTAL QUESTIONNAIRE

The supplemental questions are designed specifically for this recruitment. Applications received without the required supplemental information will be screened out of the selection process. Employment experience referred to in your response must also be included in the Employment History section of the application.

NOTE: Please answer the question(s) below as completely and thoroughly as possible, as your answer(s) may be used to assess your qualifications for moving to the next step in the recruitment process.

1. Describe, with examples, how you evaluate criteria for different levels of behavioral health treatment, including evaluation for different levels of care for both mental health treatment and substance use disorder treatment. Include in your answer criteria for appropriately accessing services at inpatient, residential and outpatient settings. What are the critical elements to assess? What are cultural and ethnic factors to consider in your evaluation?

2. Describe your experience training clinical staff in regulatory compliance and documentation standards, particularly in the areas of cultural and linguistically appropriate charting and gender-inclusive care.Describe any experience you have either processing or training others regarding client’s rights; topics such as grievances, appeals or sentinel events/incident reports. Describe your experience with electronic health records, and training others in the use of electronic health records.

3. Describe your experience with multidisciplinary project collaboration, leadership/oversight, and outcome monitoring; and include any specific experience addressing multi-agency or multi-team data-driven improvement projects.

EMPLOYEE BENEFITS:

• ANNUAL LEAVE - 22 days first year, increasing to 37 days after 15 years of service. Available for vacation and/or sick leave.
• HOLIDAYS - 14 paid holidays per year.
• BEREAVEMENT LEAVE - 3 days paid in California, 5 days paid out-of-state.
• MEDICAL PLAN - The County contracts with CalPERS for a variety of medical plans. For most plans, County contributions pay a majority of the premiums for employees and eligible dependents.
• DENTAL PLAN - County pays for employee and eligible dependent coverage.
• VISION PLAN - County pays for employee coverage. Employee may purchase eligible dependent coverage.
• RETIREMENT - Pension formula 2% at age 60 or 2% at age 62 as determined based on provisions of the CA Public Employees’ Pension Reform Act of 2013(PEPRA). Pension benefit determined by final average compensation of three years. County participates in Social Security.
• LIFE INSURANCE - County paid $20,000 term policy. Employee may purchase additional life insurance.
• DISABILITY INSURANCE - Employees in the General Representation Unit participate in the State Disability Insurance (SDI) program. This program is funded 100% by employee payroll deductions.
• DEPENDENT-CARE PLAN - Employees who make contributions for child or dependent care may elect to have their contributions made utilizing “pre-tax dollars.”
• H-CARE PLAN - Employees who pay a County medical premium may elect this pre-tax program.
• HEALTH CARE FLEXIBLE SPENDING ALLOWANCE (HCFSA) - Employees may elect this pre-tax program to cover qualifying health care expenses.
• DEFERRED COMPENSATION - A deferred compensation plan is available to employees.

Note: Provisions of this bulletin do not constitute an expressed or implied contract.

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