Job Description

WHO WE ARE: La Clínica de La Raza is a community-based health center committed to providing culturally appropriate, high-quality, and accessible health care to the diverse communities of the San Francisco Bay Area. We have spent over 40 years advocating for and creating a health home for the many that have been denied access to care. As health care activists, we are dedicated to making sure individuals who do not have health coverage get the same level of quality healthcare as those who have it.

Under the general direction of the Operations Administrator of Behavioral Health this lead position is responsible for assuring compliance with La Clínica, governmental, and external agencies' standards, policies, and procedures for quality and accurate documentation in Mental Health Programs, manage the authorization and utilization review process for Medi-Cal/Other Health Insurances provided for in our outpatient mental health treatment programs/and services, oversees peer review processes, performs charts reviews and internal audits, signs off on documentation, provides training to and interfaces with paraprofessional and professional staff members, and external review agencies to ensure clients receive the best and most appropriate care.

MAJOR AREAS OF RESPONSIBILITY INCLUDE BUT ARE NOT LIMITED TO: 

TRAINING & CONTINUOUS QUALITY IMPROVEMENT

1. Develops and implements initial onboarding training modules and ongoing training for Clinicians, Students and Peer Staff.
2. Develops materials and practice guidelines on documentation and charting requirements.
3. Provides one-to-one and group training on assessment, diagnosis, treatment planning, progress notes and other documentation requirements for behavioral health department staff including peer coaches, clinicians, supervisory staff, and managers.
4. Provides direct feedback to staff regarding areas of strength and areas for improved charting.
5. Participates on continuous improvement initiatives related to service delivery, evaluating client outcomes, implementation of evidence based practices as well as improvements in the documentation of services.

QUALITY ASSURANCE/AUDITS PREPARATION AND RESPONSE

1. Works with local representatives to ensure La Clínica complies with Medi-Cal/Other Health Insurance authorization requirements and utilization review regulations.
2. Reviews client records documentation to ensure compliance with regulations relating to medical necessary, accuracy and completeness of all required documentations and identifies areas for training and improvement.
3. Conducts chart and service audits with feedback/findings provided to staff, supervisors and managers.
4. Prepares behavioral health department for audits.
5. Develops corrective action plans as needed and is responsible to ensure corrective action plans are followed.

SUPERVISION

1. Provides day to day consultation to staff and students regarding clinical issues and documentation questions.
2. Provides direct supervision to assigned staff and students.
3. Provides feedback to department managers and supervisors regarding areas for improvement for each staff member based on orientation, ongoing training and review of charting strengths and areas for improvement.
4. Performs other duties as assigned.

REQUIREMENTS

1. Licensed Clinical Social Worker, Marriage and Family Therapist, or Clinical Psychologist with at least one (1) year of experience in the Medi-Cal utilization review process. Two years QA/QM and Training experience .
2. Understanding of pertinent laws and regulations regarding Medi-Cal mental health program and the ability to apply state, federal, and local regulations related to quality assurance and quality improvement activities.
3. Knowledge of Medi-Cal specialty mental health services, and treatment of mental health and co-occurring mental health and substance abuse problems in an outpatient setting.
4. Ability to work as part of a comprehensive community mental health team, to foster a positive team of professionals and to foster a positive work environment.
5. Experience providing training on documentation standards and/or regulatory standards.
6. Knowledge of MS Word, Excel, and PowerPoint required.
7. Strong organizational skills with high level of attention to details.
8. Knowledge of Evidence Based Practices and their application to public community mental health services.
9. Bilingual (Spanish/English) preferred but not required.