Utilization Review Specialist
Government of the District of Columbia - Washington, DC

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"Pay Plan, Series & Grade: DS-601-12

Agency: Department of Mental Health, Saint Elizabeths Hospital, Office of the Chief Clinical Officer

Area of Consideration: Unlimited

Opening date: October 4, 2012

Closing Date: Open Until Filled

First Screening Date: 10-18-2012 and every two weeks thereafter

Collective Bargaining Unit (Non-Union): This position is not in a collective bargaining unit.

Duration of Appointment: Permanent

Number of Vacancies: One (1)

Promotion Potential: None

Salary Range: $62,499 - $79,959 per annum

Tour of Duty: 8:30 a.m. - 5:00 p.m. Monday through Friday


Brief Description of Duties: The Utilization Review Specialist performs studies/reviews of medical records to monitor and to determine that the quality of clients┬┐ treatment and care are maintained at the highest level. This includes examining and evaluating various components of client┬┐s medical records to bill for Medicare/ Medicaid reimbursement and commercial insurance for about 92 to 105 clients with insurance. These numbers may vary from month to month. When assessing the documentation, the incumbent adheres to the policies and various guidelines, set by internal and external bodies, such CMS and JACHO. During each assessment, the incumbent identifies problems trends and deficiencies related to admissions, continued hospital stay, treatment plan care and discharge planning. Daily assessments of records are conducted to determine continued stay for each billable client. Additionally, the incumbent identifies problems, trends, and deficiencies, and factors requiring examination, evaluation and/or resolution as a result of reviewing various clinical documentations, data, methods and procedures related to admissions, continued hospitalization, treatment and care.


Basic Requirements: Basic Requirements: Candidates must have completed a full four (4) year course of study in an accredited college or university leading to a bachelors or higher degree with major study in an academic field relating to the health science or allied science pertinent to the position. In addition to meeting the basic requirement, this position requires one (1) year of specialized experience equivalent to the next lower grade level. Specialized experience is experience which is directly related to the position to be filled and which has equipped the candidate with the particular knowledge, skills and abilities to successfully perform the duties of the position to be filled.

Selective Placement Factor(s): Nursing degree and/or JCAHO experience preferred.

Ranking Factors

Submission of Ranking Factors: The following ranking factors will be used in the evaluation process. All applicants MUST respond to the ranking factors. Please respond specifically to the ranking factor(s) by either typing directly into the free form area provided or by pasting from a text document. Please describe specific incidents of sustained achievements from your experience that show evidence of the level at which you are applying. You may refer to any experience, education, training, awards, outside activities, etc. that include the degree to which you possess the job related knowledge, skills and abilities described in the ranking factors. The information given in response to the ranking factors should be complete and accurate to the best of your knowledge. FAILURE TO RESPOND TO ALL RANKING FACTORS WILL ELIMINATE YOU FROM CONSIDERATION.

Ranking Factor #1: Advanced knowledge of mental health concepts, principles, practices, issues, programs and operations based on professional training in health care methodologies.

Ranking Factor #2: Detailed knowledge of quality assessment and improvement (QAI) documentation requirements as related to SEH accrediting and certifying bodies.

Ranking Factor #3: Advanced knowledge of the Department of Mental Health and Saint Elizabeths Hospital policies, goals and objectives, operating procedures, rules and regulations.

Ranking Factor #4: Detailed knowledge of techniques for record review methods, evaluation of clinical documentation and clinical interventions in the medical records review.

Ranking Factor #5: Skill in both written and oral communications to provide consultation, training, prepare reports; make oral presentations, and present finding regarding medical record reviews.

Priority Consideration

Displaced Employee Priority Placement: Eligibles for the District of Columbia's Displaced Employee Program (DEP) and Agency Reemployment Priority Placement Program (ARPP) will be given priority consideration for this position if found qualified.

Residency Requirement

A person applying for a position in the Career Service, Educational Service, Management Supervisory Service, an attorney position in the

Legal Service (series 905) other than in the Senior Executive Attorney Service (SEAS), who is a bona fide District resident AT THE TIME OF APPLICATION for the position, may be awarded a 10-point residency preference over non-District applicants, unless the person declines the preference points. If selected, the person shall be required

to present no less than 8 proofs of bona fide District residency and maintain such residency for 7 consecutive years from the effective date of the appointment. Failure to maintain bona fide

District residency for the 7-year period will result in forfeiture of employment.

Information to Applicants

Veterans Preference: Applicants claiming veterans preference must submit official proof at the time of application.

Drug-Free Workplace: Pursuant to the requirements of the Drug-Free Workplace Act of 1988, the individual selected to fill this position will, as a condition of employment, be required to notify his/her immediate supervisor, in writing, not later than five (5) days after conviction of or a plea of guilty to a violation of any criminal drug statute occurring in the workplace.

How to Apply

Disposition of Resume: Resumes received outside the area of consideration and/or after the closing date will not be given consideration. You must resubmit your resume to receive consideration for any subsequent advertised position vacancies. For the purpose of employment, resumes are not considered job applications. Therefore a DC 2000 job application or online job application is required to be submitted.

Posting Cancellation: A non-competitive selection of an eligible candidate from the Agency Reemployment Priority Placement Program (ARPP) or the District's Displaced Employee Program (DEP) will result in the cancellation of this announcement.




ROOM 205




PHONE: (202) 299-5211

FAX: (202) 561-6943

Closing Statement

Job Offers: Official Job Offers are made by the Office of Human Resources Only.

EEO Statement: The District of Columbia Government is an Equal Opportunity Employer.

Equal Opportunity Employer: All qualified candidates will receive consideration without regard to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, family responsibilities, matriculation, physical handicap, or political affiliation.

Notice of Non-Discrimination: In accordance with the D.C. Human Rights Act of 1977, as amended, D.C. Official Code, Section 2-1401.01 et. seq., (Act) the District of Columbia does not discriminate on the basis of actual or perceived: race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, gender identity or expression, familial status, family responsibilities, matriculation, political affiliation, genetic information, disability, source of income, or place of residence or business. Sexual harassment is a form of sex discrimination which is also prohibited by the Act. In addition, harassment based on any of the above protected categories is prohibited by the Act. Discrimination in violation of the Act will not be tolerated. Violators will be subject to disciplinary action.

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