Prior Authorization Utilization Review Jobs in Reston, VA

Job Announcement

Are you a knowledgeable behavioral health professional seeking ways to support youth with intensive needs and their families from our community? Do you have an interest in system-level work by building collaborative partnerships to promote access to high-quality care? Do you have skills navigating policy and managing detailed information?
If so, we invite you to apply for the position of Children's Services Act (CSA) Utilization Review Manager. This is an exciting time to join Fairfax-Falls Church System of Care as a member of the CSA team to meet the behavioral health needs of children and youth in our community.
This position plays a critical role in serving children and families in our community who require intensive behavioral health interventions and support. Supervises a team of senior clinicians to review requests for services and authorize funding for a continuum of services and supports. Working closely with staff from child-serving agencies such as child welfare, juvenile justice, special education and community mental health, the UR team ensures that high quality, effective interventions that are trauma-informed and evidence-based are offered. This position works closely with quality assurance, procurement, fiscal teams and data analytics to balance service delivery with effective, outcome- focused interventions. This position requires a detail-oriented and analytical professional who can manage and interpret complex policy and unique child-specific needs in a dynamic human service environment, working collaboratively with various partners to implement a System of Care model.
Under general guidance of the CSA Program Manager, performs the following duties and responsibilities:

• Supervises and manages a team of behavioral health senior clinicians to review and authorize requests for intensive behavioral health services and supports
• Provides oversight to ensure service authorizations comply with state and local policy meeting programmatic and fiscal audit standards
• Participates in management and leadership teams as well as interagency workgroups to support strategic initiatives aimed at improving equitable access, effective service delivery and improved outcomes for youth involved in child welfare, juvenile justice and special education
• Leads collaborative efforts and engages with private provider partners to ensure a full continuum of high quality, trauma-informed and evidence-based interventions are available
• Supports implementation of the System of Care model in Fairfax-Falls Church to accomplish strategic priorities for youth with complex, intensive needs
• Utilizes technology solutions, electronic documentation systems, and virtual platforms for efficient business processes in a dynamic human services environment.
• Collects and analyzes qualitative and quantitative data to provide management reports to leadership about service trends, gap analyses and other program metrics

Illustrative Duties

(The illustrative duties listed in this specification are representative of the class but are not an all-inclusive list. A complete list of position duties and unique physical requirements can be found in the position description.)

• Provides staff supervision for all clinical aspects of the program;
• Plans, assigns, and reviews work of team members;
• Consults with professionals on a variety of problems including delivery of needed services for clinically complex cases;
• Provides liaison to community agencies to facilitate communication and service provision for individuals requiring multiple services;
• Develops and implements program activities and services, including training and educational activities;
• Supervises day-to-day program operations;
• Promotes awareness of program services through presentations;
• Develops and monitors program's policies and procedures;
• Ensures that program is in compliance with applicable federal, state, and local policies, regulations, and statutes;
• Mediates and facilitates inter-and intra-program issues needing a systems perspective;
• Plans, recommends, and executes quality initiatives related to mental health standards;

Required Knowledge Skills and Abilities

(The knowledge, skills and abilities listed in this specification are representative of the class but are not an all-inclusive list.)

• Extensive knowledge of the principles, theories, and methods of the psychological and social development of humans;
• Thorough knowledge of and ability to implement recovery oriented practices and person-centered planning;
• Knowledge of psychiatric, psychological, sociological, and addiction terminology and concepts;
• Knowledge of clinical supervisory methods and techniques;
• Knowledge of existing referral agencies and community resources;
• Demonstrated case management skills;
• Ability to evaluate the severity of individuals' substance use, psychiatric symptoms, and impact on daily functioning; and implement commensurate level of treatment and support;
• Ability to prepare, produce, and conduct program presentations;
• Ability to develop, implement, manage, and evaluate programs;
• Ability to supervise and train service professionals;
• Ability to successfully perform as a team leader/member;
• Ability to evaluate performance, provide feedback, coach, correct, and implement personnel procedures;
• Ability to function independently in high stress situations;
• Ability to develop and maintain effective working relationships with subordinates, co-workers, supervisors, public and private sector organizations, community groups, and the general public;
• Ability to successfully perform as a team leader/member;
• Ability to communicate effectively, both orally and in writing;
• Ability to maintain records and prepare reports.

Employment Standards

MINIMUM QUALIFICATIONS:
Graduation from an accredited college with at least a master's degree in social work, psychology, counseling, or nursing plus three years of clinical experience or a doctoral degree in psychology, social, counseling or nursing plus one year of clinical experience.
Must be eligible to be licensed to practice in the Commonwealth of Virginia in one of the following: Licensed Clinical Social Worker, Licensed Professional Counselor, Clinical Psychologist, Licensed Marriage and Family Therapist, Licensed Substance Abuse Treatment Practitioner or Licensed Nurse Practitioner (LNP).
CERTIFICATES AND LICENSES REQUIRED:

• Licensed to practice in the Commonwealth of Virginia in one of the following: Licensed Clinical Social Worker, Licensed Professional Counselor, Clinical Psychologist, Licensed Marriage and Family Therapist, Licensed Substance Abuse Treatment Practitioner or Licensed Nurse Practitioner (Required within 24 months)
• Valid driver's license

NECESSARY SPECIAL REQUIREMENTS:
The appointee to this position will be required to complete a criminal background check, child protective services check, and driving record check to the satisfaction of the employer.
PREFERRED QUALIFICATIONS:

• At least 3 years of experience with supervision of professional staff
• At least 2 years of professional human services work experience in at least two areas.
• At least 2 years of professional experience monitoring behavioral health care services.
• Advanced knowledge of trauma-informed, evidence-based mental health/behavioral health care interventions for children, youth and families.
• At least 2 years of experience in at least two of the following areas: utilization review, monitoring of purchased mental health/behavioral health care service, collection of standardized data elements via file audits and document reviews, preparing written social histories, assessments, and reports describing the needs of children and families, and use of assessment tools (examples: CANS, VEMAT, YASI, etc.) and decision support models
• At least intermediate proficiency with Excel.

PHYSICAL REQUIREMENTS:
Ability to communicate clearly and concisely, both orally and in writing. Ability to travel to visit clients, conduct site reviews and attend meetings off-site. Ability to use automated technology. Employee may require to lift up to 15 lbs (all duties). Visual acuity is required to read data on computer monitor, incumbent must be able to operate keyboard driven equipment. All duties performed with or without reasonable accommodations.
SELECTION PROCEDURE:
Panel interview and may include exercise.
Fairfax County is home to a highly diverse population, with a significant number of residents speaking languages other than English at home (including Spanish, Asian/Pacific Islander, Indo-European, and many others.) We encourage candidates who are bilingual in English and another language to apply for this opportunity.
Fairfax County Government prohibits discrimination on the basis of race, color, religion, national origin, sex, pregnancy, childbirth or related medical conditions, age, marital status, disability, sexual orientation, gender identity, genetics, political affiliation, or military status in the recruitment, selection, and hiring of its workforce.
Reasonable accommodations are available to persons with disabilities during application and/or interview processes per the Americans with Disabilities Act. TTY 703-222-7314. DHREmployment@fairfaxcounty.gov EEO/AA/TTY.
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