Family Services Specialist Iii

City of Virginia Beach Department of Human Services is seeking an experienced Utilization Review Specialist to operate within the Children’s Services Act (CSA) office primarily and the Office of Program Support (OPS). This position is responsible for collaborating with the Family Assessment Planning Teams (FAPT) and the CSA Administrator to implement the local utilization management plan also known as the Continuous Quality Improvement (CQI) plan to evaluate the quality and appropriateness of intensive treatment services purchased for youth and families served through the Children’s Services Act (CSA) Office. This position takes on the lead role for assessing the quality and appropriateness of provider services to individual youth and their families through site visits, chart reviews and clinical interviews. The incumbent will heavily support the CSA Administrator in adhering to the Code of Virginia, (§2.2-2648 D.15, §2.2-5206.13, and §2.2-5208.5), require the CSA office to collect, review, and analyze aggregate CSA data and assist with the development of long-range program planning.

This position monitors recommended funding sources to ensure CSA maximizes the use of alternative funding streams such as DMAS/Medicaid when appropriate and Providers remain in compliance with DMAS requirements. In addition, this position supports the OPS in management of vendor contracts and licensing regulations, and knowledge of purchased services and interventions. The incumbent will work very closely with the CSA Administrator and the Family Assessment Planning Team (FAPT) to monitor providers, provide utilization data to the Community Policy Management Team (CPMT) and ensure quality services to youth and families.

Duties:

• Works collaboratively with the FAPT Coordinator to ensure CANS are up to date and accurately support the current level of service being provided to child.
• Use various electronic health record/records management systems to provide utilization review for the office of Children’s Services Act.
• Reviews medical, behavioral, and clinical documentation in files to ensure that the child is receiving high quality and appropriate services in compliance with the CSA Vendor contract and all federal, state, and local regulations; ensures all medications are prescribed and documented accurately and in accordance with all licensing regulations as well as federal, state, and local policies.
• May coordinate and/or facilitate FAPT meetings in the absence of and/or in conjunction with the FAPT Coordinator.
• Conducts site visits of new providers who are being considered for the Virginia Beach CSA Provider Network prior to contract approval.
• Collaborates with FAPT and CSA Administrator to review the information received from Provider evaluations and follows up on complaints or issues.
• Perform other duties as assigned.
• Utilizes CANS data in CANVaS system to track changes in an individual child’s CANS scores as a result of treatment services provided.
• Researches and utilizes regulatory manuals, provider manuals, local policy and state guidelines to provide guidance to providers, case managers, FAPT and other CSA stakeholders.
• Tracks and monitors the utilization of Intensive Care Coordination (ICC) services and prepares utilization and outcome reports to the CPMT monthly and prepares utilization and outcome reports to the CPMT.
• Assists with identifying the gaps in services and identifying new resources to meet these gaps in client needs.
• Identifies cases that are appropriate for ICC while youth is in congregate care and collaborates with FAPT and the case manager to discuss the use of ICC services.
• Conducts case conferences as needed to assist case managers outside of FAPT to secure quality services best matched to their client’s needs.
• Collect, track, review, and manage all DMAS/Medicaid authorizations and denials.
• Assists parent self-referrals for information and services as needed.
• Adhere to federal, state, and local policies associated with CSA.
• Reviews provider treatment plans and progress reports to ensure they support the child’s Individualized Family Service Plan (IFSP), Child and Adolescent Needs and Strengths (CANS) Assessment, mental health diagnosis and discharge plan and reflect the progress of the child and the interventions by the facility’s staff and treatment team.
• Conducts site reviews of congregate care facilities to include interviews with members of the child’s treatment team and privately with the child to evaluate the services, environment, client’s view, level of family engagement and progress towards discharge.
• Attends Community Policy & Management Team meetings.
• Inspects charts for documentation of family participation to include method, frequency and progress towards discharge goals.