Description

The Department of Children, Youth, and Families (DCYF) was created to be a comprehensive agency exclusively dedicated to the social, emotional, and physical well-being of children, youth, and families regardless of race, ethnicity, sexual orientation, or other socioeconomic factors. We believe our workforce should reflect the communities we serve and are actively searching for candidates that reflect that diversity.

The Opportunity:
We're looking for a Statement of Medical Necessity Specialist (PS5) to join our team and as the Subject matter expert responsible to determine Medical Necessity for children and youth referred to or receiving services from Behavior Rehabilitation Services (BRS) contracted by DCYF in order to qualify for services and for DCYF to draw down federal Title 19 funds. This position will work statewide with field staff and coordinate with the headquarters Continuum of Behavioral Health and Placement Continuum units. This position will gather information on referred children and youth, review files, mental health criteria, BRS referrals, and FamLink. The position partners with the Health Care Authority (HCA), mental health providers, and Coordinated Care of WA Apple Health Core Connections (AHCC) to make a timely medical necessity determination. This position has a quality assurance role that ensures compliance with state and federal regulations, and that the children and youth with complex behavioral health needs receive this intensive BRS-level of care.

Some of what you will get to do:

• Gather and review documentation and information in FamLink and from other sources including, but not limited to BRS application, files, reports, coordination with field and BRS, hospitals, mental health centers, managed care organization plan, and contracted providers to establish the Statement of Medical Necessity and/or continuation of Medical Necessity.
• Assess available information, seeking clarification and additional information as needed to determine the Medical Necessity of the child or youth to receive or continue receiving BRS services.
• Make determinations and write clear, comprehensive reports.
• Clearly articulate and communicate rationales for determination.
• Collaborate with internal and external partners to inform program development and improvements related to the referral and review processes.
• Track and analyze outcomes and performance data to inform determination consistency, program status, and improvements.
• Develop and submit quarterly reports

What we are looking for (Required Qualifications):

• Master’s Degree in Mental Health Counseling, Social Work, Psychology, and/or healing arts.
• Two years of post-graduate experience in completing clinical Mental Health assessments and determining the medical necessity of children and youth with Serious Emotional Disturbance (SED) in a hospital, residential, and/or community-based mental health setting. One year post-licensure may be waived for one year of working in children’s mental health/and social work with supervision while obtaining licensure.
• Current/Active Licensure in WA State in Mental Health (including LICSW, LMHC, LMFT), Psychological (PsyD, PhD), Advanced Registered Nurse Practitioner (ARNP), and/or MD.
• Understanding of Medical Necessity Criteria and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

The ideal candidate will also possess some or all of the following:

• Demonstrated knowledge of social service principles and practices; goals and objectives of case planning and risk assessment.
• Demonstrated knowledge of protecting vulnerable adults and children living in their own homes, and in licensed, certified settings.
• Demonstrated knowledge of Behavior Rehabilitation Services and/or Intensive Services programming and service delivery.
• Demonstrated knowledge of the Family First Prevention Services Act (FFPSA) requirements as it relates to Qualified Residential Treatment Programs (QRTP)
• Demonstrated ability in understanding Medical Necessity Criteria.
• Demonstrated strong oral and written communication skills.
• Demonstrated ability to work in a fast-paced, complex office environment with multiple conflicting priorities.
• Demonstrated collaboration, engagement, and conflict management skills.
• Demonstrated a relentless commitment to anti-racism and addressing diversity, disproportionality, and inequity.
• Demonstrated knowledge of the complex mental health needs of children and youth in the foster care system.

How do I apply?
Complete your applicant profile and attach the following:

• Resume
• Cover letter explaining how your knowledge and abilities are a good fit for this position.
• Copy of college transcripts

Supplemental Information:
**Per Governor Inslee's Directive 22-13.1 (Download PDF reader) state employees must be fully vaccinated against COVID-19. Please note that any offer of employment is contingent upon you providing verification of your vaccine status, having an approved medical accommodation, or having an approved religious accommodation. No start date will be approved until you have either verified your vaccine status or have an approved accommodation**

The initial screening will be based on the content and completeness of your application and the materials submitted. All information may be verified and documentation may be required. Applications with comments such as "see attachments" or "N/A" in the supplemental question responses will be considered incomplete.

Prior to a new hire, a background check including criminal history will be conducted. Information from the background check will not necessarily preclude employment but will be considered in determining the applicant's suitability and competence to perform in the position.

This position is covered by a Collective Bargaining Agreement.

To take advantage of Veteran's preference please attach your DD-214, member 4 long-form, or your NGB-22. Please black out your social security number prior to attaching .

DCYF is an equal opportunity employer and supports equity, diversity, inclusion and respect.

This recruitment may be used to fill multiple vacancies.

Need accommodation throughout the application/interview process? Unable to apply on-line? Contact the Recruitment team at dcyf.jobs@dcyf.wa.gov or (360)688-3529 or the Telecommunications Device for the Deaf at 800-833-6388

Experiencing technical difficulties creating, accessing or completing your application? Call NEOGOV toll-free at (855)524-5627 or email support@neogov.com.

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