Admissions & Utilization Clinician

Job Details
Job Location
Campus - Camarillo, CA
Position Type
Full Time
Education Level
Master's Degree
Salary Range
$64,480.00 - $75,000.00 Salary
Job Shift
Day
Job Category
Nonprofit - Social Services
Wage band range $64,480. to $75,000./annual
Starting salary is typically between $68,000 and $72,000 annual; however, it is ultimately determined by the scope of the position, the candidate's relevant experience, and internal equity. Position is eligible to test for additional bilingual pay incentive.
Position is eligible for $7,500 Sign-On Bonus!! Paid at 90-day, 6 months, and 1 year of active service.
Nestled in the foothills of the Santa Monica Mountains in Camarillo, Casa Pacifica's 25-acre Camino a Casa's beautiful rural setting is four miles from the Pacific Ocean and midway between Los Angeles and Santa Barbara.
Under the direction of the Admissions and Utilization Manager, coordinates and negotiates the admission of clients. Tasks include but are not limited to the following: biopsychosocial assessments, treatment plans, admits, preliminary risk screenings, concurrent utilization reviews, discharge planning and other responsibilities determined by supervisor.
The Admissions and Utilization Clinician is responsible for working directly with prospective clients, their families, insurance companies, social workers, and other referral sources on assessments and treatment plan development for adolescent mental health and substance abuse treatment. Supports systems and standards related to utilization review. The Admissions and Utilization Clinician will obtain authorization for services, coordinate with clinical and other staff on bed availability, client admission, treatment planning, and will also coordinate utilization reviews, peer-to-peer reviews, and appeals of service denials.
DUTIES AND RESPONSIBILITIES (illustrated by typical activities):

• Processes admissions to program(s) as assigned by manager.
• May assist with and schedule prospective client screenings and tours of the facilities.
• Ensures the clinical medical necessity criteria have been met prior to admission.
• Supports inpatient & outpatient treatment for potential clients.
• Establishes and maintains effective relationships with utilization managers and managed care administrators.
• Demonstrates sufficient clinical knowledge to effectively communicate the medical necessity of client treatment with utilization managers and managed care administrators.
• Conducts and assists with initial, concurrent, and discharge reviews to optimize client benefits and ensure appropriate length of treatment.
• Communicates and coordinates with relevant staff members regarding managed care decisions, including obtain timely and relevant clinical information from staff about clients, conduct peer reviews and inform relevant staff about managed care decisions.
• Assesses insurance denials, manage the appeals process and provides relevant education to clients/family members and staff.
• Maintains confidentiality in all matters within the organization with respect to personnel, operations, and clients.
• May perform other duties and projects as assigned.

EDUCATION and/or EXPERIENCE:

• Masters in social work, Marriage and Family Therapy, or Psychology preferred.
• Licensed or License eligible required.
• Two years case management, utilization review, and/or discharge planning experience in a managed care setting.
• Experience in adolescent residential treatment, partial hospitalization, and/or intensive outpatient programs preferred.
• Experience completing clinical assessments for mental health and substance abuse treatment and coordinating inpatient and outpatient related treatment with providers.

CREDENTIALS: MFT, CSW, Psy.D., Ph.D.
OTHER SKILLS AND ABILITIES:

• Understanding of commercial insurance regulations and practices
• Understanding of current utilization/quality management principles, techniques, and procedures
• Possesses negotiation and advocacy skills and abilities.
• Strong computer skills - Word, Excel, Outlook, Electronic Health Record
• Excellent written and verbal communication skills.
• Ability to maintain professionalism and confidentiality in all aspects of position.
• Strong interpersonal and organizational skills
• Self-starter, creative thinker with strong social and customer service skills
• Ability to manage several projects at one time. Organized and able to function well in a busy environment including the ability to switch gears easily and multi-task.
• Demonstrated ability to work collaboratively yet function independently.
• Ability to interact with children and their families in a nurturing way with a positive and patient demeanor.

Casa Pacifica offers:

• Comprehensive Benefits Package, including 401k with up to 5% fully vested employer matching contributions made after the first year of service
• Medical, Dental & Vision Insurance options
• Flexible Spending and Dependent care programs
• Excellent Training opportunities
• Education/Tuition Assistance programs
• Group Discount Pet Insurance
• Aflac Critical Illness, Accidental & Dental supplemental plan options
• Employee Assistance Program
  • Free Confidential Crisis Line 24/7 (365 days a year)
  • 4 face-to-face or telephonic sessions per issue, i.e.,
    • Stress, Anxiety, Depression
    • Life transitions
    • Grief and Loss
    • Divorce
    • Conflict Resolution
    • Substance Abuse
    • Work-Life Counseling
    • Free Legal and Financial Consultations
    • Identity Theft Recovery Service
    • Teamwork and Relationships

Casa Pacifica restores hope, enhances resilience, and strengthens community connections for children, young adults, and families.
We are a diverse and inclusive team providing excellent services to all our communities. Our team members are empowered to share their identities, ideas, and perspectives. A culture built on diversity, equity and inclusivity is essential to creating a safe and healing environment at Casa Pacifica.
Casa Pacifica is proud to be an equal employment opportunity employer; all applicants will be given full consideration under state, local, and federal law.