- Based on documentation, determining appropriate levels of patient care
- Obtaining information from providers on psychiatric requests for treatment
- Determining if documentation meets medical necessity requirements for payment through Medicaid or the County of San Diego
- Managing inpatient, outpatient, crisis residential mental health cases throughout the entire treatment plan
- Data entry of clinical documentation submitted into the County’s Electronic Health Record or Designated Database
- Administering benefits and reviewing treatment documentation
- Coordinating benefits and transitions between various levels of care
- Identifying ways to add value to treatment plans and consulting with facility staff or outpatient care providers on those ideas
- Support other sub teams within Utilization Management as needed with authorizations for treatment at Residential Substance Use programs and Long Term Care facilities
- Support the San Diego Access and Crisis Line as needed
- Sign off on paper work products in office from the inpatient hospitals, such as the Treatment Authorization Request
- Licensed, Master's Degreed Clinician in Psychology, Social Work, Counseling, or Marriage / Family Counseling, a Licensed Ph.D., or an RN with experience in behavioral health
- Licenses must be independent, active and unrestricted in the State of California
- 2+ years of experience in mental health / behavior health environment
- Intermediate level of computer proficiency (including MS Word, Excel, Outlook, Teams)
- Live and work within a commutable distance and be willing to work in the San Diego office as needed
- Must be able to obtain and maintain access to the County of San Diego’s electronic health records
- EHR experience
- Experience in a managed care setting
- Dual diagnosis experience in mental health and substance use treatment
- Medi-Cal system experience
- Experience working in an environment that requires coordination of benefits and utilization of multiple groups and resources for patients
- Experience in telephonic roles
- Proven solid data entry skills
Professional Field
Counseling
Social Work
Other Behavioral, Mental, or Healthcare Field
PsychologyPatient Focus
Diagnoses
Avoidant Personality Disorder
Gender Dysphoria
Issues
Aging
Age Groups
Preteens/Tweens (11-13)
Therapeutic Approach
Methodologies
ECT
Modalities
Families
Practice Specifics
Populations
Individuals with Addiction Issues
Victims of Crime/Abuse (VOC/VOA)
Racial Justice Allied
Settings
Residential
Faith-based organizations
In-patient Non-Psychiatric
In-patient Psychiatric
Milieu
Nursing Home
Partial Hospitalization (PHP)
Private Practice
Research Facilities/Labs/Clinical Trials
Schools
Telehealth/Telemedicine
Home Health/In-home
Long-Term Structured Residences
Military






