Utilization Review Technician jobs in San Francisco, CA

ABOUT MARINHEALTH a UCSF Affiliate

Come and be a part of our healing team at the award-winning MarinHealth! Ranked in the top 3% of general hospitals in the country, we have made great strides since returning to our roots as an independent hospital. As Marin County’s only acute hospital and a vital resource for a wide range of essential health care services, it is our mission—and our passion—to excel in every medical specialty. We attract the finest physicians and employees who appreciate having the best of both worlds: the resources and medical sophistication of an academic medical center combined with the personalized, caring touch of an independent hospital.  We have an exceptionally collaborative team that adheres to the highest service excellence standards to ensure that we deliver world-class, personalized care to patients. Our Joint-Commission accredited hospital has won numerous awards and certifications in delivering best-in-class health care in the San Francisco Bay Area.

WHAT WE OFFER

MarinHealth offers a generous suite of employee benefits, which includes a comprehensive and rich health benefits program (medical, dental, vision and prescription plans). Our robust Wellness @ Work program (e.g. onsite health & fitness classes, discounts, etc) also promotes a healthier lifestyle for employees and to support you on your Healthy Healer journey. Other benefits include, but are not limited to, a 403(b) contribution plan and company-funded retirement plan, life insurance, vacation, holiday and sick leave, which you will start accruing immediately. Our benefits are highly competitive and considered to be one of the best in the Bay Area! Find your healing place at MarinHealth.

External hires are subject to a background check and pre-employment medical screen .  Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with federal, state and local laws.  All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classifications protected by federal, state & local laws.

JOB SUMMARY:

The LCSW provides Outpatient comprehensive clinical social work practice and case management to all special needs patients by providing non-discriminatory, comprehensive treatment and coordination of care to patients and them. The LCSW provides age specific psychosocial screening, psychiatric assessments, psychosocial assessment, clinical interventions and treatments.

JOB SPECIFICATIONS:

EDUCATION

Master's degree from an accredited school of social work required.

EXPERIENCE

LCSW I: Prior work experience in a health care environment required.  Acute care hospital experience preferred.

LCSW II: At least two years in MGH Behavioral Health Department with progressing leadership responsibility.

PREREQUISITE SKILLS

• Knowledge of psychosocial aspects of illness including family systems theory, crisis theory and effective treatment modalities used to assist patients and their families in adjusting to the debilitating effects of illness.
• Knowledge of age specific theories of human development; social work theory and practice as well as applicable community resources and legal aspects of care for varying populations and assigned hospital units.
• Significant independent judgment, analytical, problem-solving and collaborative skills in order to organize and prioritize multiple tasks, providing patient-centered leadership and direction.
• Adheres to professional ethics, practice and values as delineated by NASW.
• Demonstrates knowledge, ability and willingness to engage in continuous learning about various ethnic, spiritual, and culturally diverse backgrounds.
• Demonstrates expertise and knowledge of DSM IV-R diagnoses.
• Demonstrates expertise and knowledge on reporting laws as well as all legal aspects of care (W & I Codes, Title 22, CMS, etc.) relevant to specific population serviced.
• Demonstrates compliance in continuous learning and professional leadership skills.
• Demonstrates knowledge of the managed care system and utilization review procedures with private insurance companies and county mental health plans.

LICENSE / REGISTRATION / CERTIFICATION:

• Current California Clinical Social Worker (LCSW) license (Board of Behavioral Health Examiners)
• Certified as a Basic Life Support provider (BLS) within 90 days of hire
• Certified as Spanish Language Translator within 90 days of hire (WIC Clinical Social Worker only)

PRIMARY CUSTOMER SERVED (Age Specific Criteria):

[X] Infants                             Birth to 1 year

[X] Toddlers                           1 to 3 years     

[X] Preschool Children             3 to 6 years     

[X] School Age Children           6 to 12 years

[X) Adolescents                      12 to 18 years

[X] Early Adults                      18 to 45 years

[X] Middle Adults                    45 to 61 years

[X] Late Adults                        61 to 79 years 

[X] Late, Late Adults                80 years and up

Employees in this position must be able to demonstrate the knowledge and skills necessary to provide care and/or service based on the physical, psycho/social, educational, safety, and related criteria appropriate to the age of the patients served in his/her assigned service area.

PATIENT PRIVACY (HIPAA Compliance):

Employees in this position have access to protected health information.  The protected health information a person in this position can access includes demographics, date of service, insurance/billing, medical record summary information, and all other information that may be contained in patient records. This position requires patient health information to perform the functions outlined as part of this position description.

DUTIES AND RESPONSIBILITIES:

ESSENTIAL (not modifiable)

Clinical

1. Provides psychosocial assessments and treatment to patients and or families related to adjustment to illness.
2. Demonstrates knowledge and skills necessary to provide cultural, spiritual and age specific care by obtaining specific care information and assessing relevant information needed to identify each patient’s unique treatment needs.
3. Performs unit/department/program specific comprehensive psychosocial assessments, ensuring pediatric, adult and elderly patient’s age-related needs and coping mechanisms are clearly identified.
4. Through comprehensive psychosocial and or psychiatric assessments (5150), formulates accurate diagnostic impressions in order to facilitate treatment.
5. Acts as patient advocate and resource regarding patient’s needs including financial considerations.
6. Possesses clinical expertise to effectively assess, coordinate, implement and evaluate all services required to meet the needs of the patient.
7. Provides individual, conjoint family and group therapy as appropriate to setting. 

Collaborative

1. Maintains effective communications with staff and attending physicians related to patient’s psychosocial and psychiatric needs.
2. Maintains open communication and positive working relationships with all hospital departments as well as adheres to hospital chain of command.
3. Willing to assist others and supports other hospital personnel in providing optimal patient care.
4. Demonstrates a clear understanding and adheres to designated unit/department/program as well as overall policy and procedure.
5. Collaborates with physicians, patients, families and treatment team members in the development of the patient’s plan of care.
6. Assists and promotes patient/family education and ensures that the patient’s educational needs are being met.
7. Works with public and private sectors (i.e. public guardian’s office) to ensure best treatment outcomes as well as completes necessary documents consistent with LCSW scope of practice.  Oversees physician’s need for timely submission of legal documents.
8. Provides clinical information for placement and referral to outside agencies consistent with HIPAA and state guidelines for special needs populations.
9. Interprets and cites applicable laws and regulations to staff and physicians pertinent to individual patient needs.
10. Provides clinical supervision to master’s level social work interns as well as interprets psychosocial information to other healthcare professionals, including nursing students.

Care Coordination

1. Maintains and provides current information and referral services to patients, caretakers and families related to appropriate community resources and agencies.
2. Maintains knowledge of current eligibility criteria for a wide array of community resources.
3. Maintains positive working relationships with community agencies.
4. Utilizes and expands knowledge base of community resources.
5. Initiates contact with state, county and private resources, including family, to facilitate discharge to the least restrictive level of care.
6. Provides advocacy for clients in accessing appropriate community-based resources.
7. Develops and implements discharge plan for all special-needs patients.

Documentation

1. Provides accurate, clear, concise, relevant and timely documentation in patient’s charts according to individual units/departments/programs documentation system and their adherence to specific CMS and State regulations.
2. Maintains consistent and clear documentation on daily assessment of patients related to care plan.
3. Documents timely initial psychosocial assessment according to unit/department/program’s standard of care.
4. Documents all collateral contracts.
5. Documents all care coordination efforts, including timely insurance reviews.
6. Documents treatment planning according to each units / departments / program standards by using each unit / departments / programs specific forms.
7. Maintains confidentiality of privileged communication with patients and families adhering to Clinical Social Work Practice.

Additional Essential Functions for LCSW II:

• Works in a patient care unit performing primary independent case management duties, including utilization review and/or
• Participates in meetings and committees relevant to specific treatment area/department/program and represents MGH at relevant community meetings and committees.
• Assists in the development and evaluation of patient care Policies and Procedures.
• Provides psychosocial education and perspective to the interdisciplinary team as indicated.  Interprets and provides analysis to treatment team on how applicable laws and regulations effect discharge planning and treatments.
• Participates in Quality Improvement activities and community resource development.

SECONDARY (modifiable)

Other duties as assigned

WORKING CONDITIONS:

The following terms are used to designate the frequency of activities performed during a work shift.

MarinHealth remains committed to the health and safety of our employees, patients, and the entire community. As such, MarinHealth requires employees to receive all required immunizations, including, MMR, flu (seasonal availability), and COVID-19 vaccine booster, as a condition of employment and annually thereafter, as required.  Any exemptions from these requirements may be granted for limited and specific situations.

The compensation for this role listed on this posting is in compliance with applicable law.  The selected candidate’s compensation will be determined based on the individual’s skills, experience, internal/market equity factors, and qualifications.  This posted minimum and maximum range represents the minimum and maximum of what we reasonably expect to compensate for the position.  Furthermore, all compensation decisions are ultimately determined in accordance with our compensation philosophy.  Compensation for positions covered by collective bargaining agreements are governed by the agreements in the aforementioned document.

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