Utilization review nurse [h1.location_city]

The purpose of this position is to implement and administer the Children Services Act ( CSA ) utilization management component of the program and to ensure the provision of quality services for children / families. This position is responsible for utilization management, compliance with policy and procedures, and reporting. This position works within a general outline of work to be performed; develops work methods and sequences under general supervision.

TYPICAL TASKS

• Performs provider site visits to ensure compliance with contract guidelines, evaluates service provision and make recommendations related to ongoing contracting for services.
• Performs utilization review of cases receiving the most intensive / restrictive services as assigned.
• Communicates concerns with compliance and provides recommendations to vendors in accordance with state and local laws as well as CSA policy and procedures.
• Acts as a support to the FAPT Coordinator by serving as a back-up as assigned and when and takes FAPT minutes weekly to ensure familiarity with cases.
• Gathers and maintains information to support periodic and special reports; documents activities and events for area of responsibility and provides report to CSA Coordinator.
• Performs administrative tasks such as researching files / records, charting, typing reports, telephoning, faxing, and photocopying.
• Attends staff, team, and other professional meetings to exchange information.
• Identifies training needs and works with FAPT Coordinator to facilitate training for FAPT members and stakeholders. Performs other related duties as assigned.

Required Qualifications

VOCATIONAL / EDUCATIONAL REQUIREMENTS : Requires a bachelor's degree or any equivalent combination of education and experience in social / behavioral science or closely related field.

EXPERIENCE REQUIREMENTS : In addition to satisfying the vocational / education standards, this class requires a minimum of one year full-time related experience with social services. Auditing experience preferred.

SPECIAL CERTIFICATIONS AND LICENSES : Requires a valid driver's license and driving record in compliance with City Driving Standards .

SPECIAL REQUIREMENTS : Employees may be expected to work hours in excess of their normally scheduled hours in response to short-term department needs and / or City-wide emergencies.

Preferred Qualifications