Bhn Clinician/case Manager

Location
Fairfax, Virginia
Salary
$66,148.16 - $110,247.07 Annually
Posted
Nov 20, 2021
Closes
Dec 04, 2021
Ref
21-02111
Hours
Full Time
Job Announcement

Works with Utilization Management team at the Fairfax Merrifield Center. Provides utilization review and denials management. Utilizes nationally recognized care guidelines/criteria to assess the patient’s need for outpatient or inpatient care as well as the appropriate level of care. Interfaces with the case managers, clinicians, and payers. Performs timely and accurate utilization reviews for clients, using state-recognized care guidelines/criteria relevant to the payer. Communicates with case managers, clinical staff, and payors as needed regarding reviews and pended/denied days and interventions. Supports and facilitates concurrent appeals process through proactive identification of pended/denied days. Assures appropriate reimbursement and stewardship of organizational and patient resources. Actively reports opportunities to improve reimbursement and responds to relevant data. Collaborates with clinical staff regarding authorization policies and procedures of third-party payers. Remains current on clinical practice and protocols impacting clinical reimbursement.

This position is designated emergency series personnel and is expected to report to duty even in case of inclement weather.

This position includes a signing bonus for new employees of $2,000 (full-time).

Note: To learn more about careers that make a difference, watch our video "CSB Celebrates 50th Anniversary of Providing Care."

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 job description.)
  • Provides nursing services to clients, including administering injections, collecting vital signs, administering tests and interfacing with other nursing staff;
  • Provides nursing support to psychopharmacological services, crisis intervention, and case consultation for clients with substance use disorders or serious mental illness;
  • Administers, schedules and coordinates medication clinics/medical services, including delivery of medication, monitoring medication room, and inventorying medications;
  • Complies with state pharmacy guidelines in ordering, storage, and disposal of medications;
  • Monitors client responses to psychobiological and nursing interventions, medications and other treatments;
  • Performs quality assurance review;
  • Performs physical/mental health assessments, including laboratory testing of new clients at intake and to clients on an ongoing basis as case manager;
  • Monitors and assesses clients to identify contributing or co-occurring mental health issues;
  • Monitors and assesses clients for risk of harm to self and/or others;
  • Coordinates client plan of care to assure interventions are consistent, safe, timely and appropriate.
  • Assess continuity of care and evaluates coordination of interventions by interdisciplinary team to ensure consistency with the plan of care;
  • Provides nursing assistance and information to clients through the telephone "nurse of the day" service;
  • Manages medical needs and urgent care needs of clients;
  • Monitors and assesses medical status of clients in the process of detoxification;
  • Develops a therapeutic relationship with clients, provides supportive counseling, psycho-education, and health teaching for both individuals and groups;
  • Serves as case manager for clients for whom medication compliance is essential for remaining out of the hospital;
  • Participates on inter-/intra-agency case management teams, providing nursing consultation and effective integration between clinical and psychopharmacology services; as well as primary care services;
  • Documents assessments, treatment plans and quarterly reports on clinical status of clients;
  • Plans, develops and leads group and individual psycho-education, health education and wellness programs;
  • Provide teaching on disease, management strategies, emergency care and drug information when appropriate;
  • Researches available community, private and government resources to support patient self management of disease, recovery and relapse prevention.


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.)
  • Knowledge of nursing standards, theories, principles, practices, methods, processes, and procedures;
  • Knowledge of federal and state pharmacy and medication clinic regulations and guidelines;
  • Knowledge of documentation, nursing diagnosis, and quality assurance;
  • Knowledge of human growth and development, anatomy and physiology, pharmacology (e.g., side effects, contraindications), preventive medicine, epidemiology, and nutrition;
  • Knowledge of psychiatric, psychological, and/or sociological terminology and concepts;
  • Knowledge of substance use disorders and addiction signs and symptoms, assessment techniques, treatment interventions and approaches;
  • Knowledge of available community resources for referral or the ability to rapidly acquire such knowledge;
  • Ability to perform technical and complex nursing procedures (e.g., injections, venipuncture, blood pressure screening, STD check, tube feeding, nebulizations), administer treatments and medications, and use medical equipment in delivering services to clients;
  • Ability to perform emergency treatment(s), with limited supervision, for life threatening conditions;
  • Ability to manage a caseload;
  • Ability to perform mental and physical health assessments and apply treatment approaches/modalities;
  • Ability to assess and monitor the effects of medications;
  • Ability to assess level of risk for harm to self or others;
  • Ability to develop and implement treatment plans/programs for individuals and groups;
  • Ability to work as case manager in a multi-disciplinary team;
  • Ability to maintain effective working relationships with co-workers, public and private organizations, community groups, and the general public;
  • Ability to communicate effectively, both orally and in writing;
  • Ability to maintain records and prepare reports.


Employment Standards

MINIMUM QUALIFICATIONS:
Any combination of education, experience, and training equivalent to the following:
(Click on the aforementioned link to learn how Fairfax County interprets equivalencies for “Any combination, experience, and training equivalent to”)
Graduation from an accredited college or university with an associate degree in nursing; plus two years of post-licensure experience as a nurse.

CERTIFICATES AND LICENSURES REQUIRED:
  • Possession of a current license to practice as a Registered Nurse in the Commonwealth of Virginia or a multistate licensure privilege to practice as a Registered Nurse in Virginia.

NECESSARY SPECIAL REQUIREMENTS:
The appointee to this position will be required to complete a criminal background check, a Child Protective Services Registry check, and sanction screening to the satisfaction of the employer. A TB screening upon hire and annually thereafter.

This position is emergency/essential services personnel. (Required to report for duty during inclement weather and/or other emergencies.)

All newly hired employees are required to be fully vaccinated against COVID-19 (two weeks after the last required dose) as a condition of employment or obtain approval of a medical or religious exemption prior to their start date. Proof of an exemption or vaccination status will be required during the pre-employment onboarding process. New employees who obtain an exemption from the vaccine mandate for medical or sincerely held religious beliefs will still be subject to the weekly testing requirement. Vaccinated employees and employees with a medical or religious exemption will complete the attestation online on their first day of employment or shortly thereafter.

PREFERRED QUALIFICATIONS:
  • Extensive experience working with substance abuse and/or psychiatry nursing, medical/surgical.
  • Experience in utilization management.
  • Experience working with insurance companies.
  • Administrative supervisory experience for clinical staff.
  • Experience working with electronic health records.
  • Certification as a Qualified Mental Health Professional (QMHP)
  • Experience and proficiency in Microsoft Office (Word, Excel, PowerPoint, Outlook, etc.)

PHYSICAL REQUIREMENTS:
Ability to travel to various CSB agencies to attend essential meetings and trainings. Ability to use keyboard driven equipment and communicate clearly with others. All duties performed with or without reasonable accommodations.

SELECTION PROCEDURE:
Panel Interview and may include a practical exercise.

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. Contact 703-324-4900 for assistance. TTY 703-222-7314. EEO/AA/TTY.

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