Quality and Utilization Director
Agency Name: Woodlands Behavioral Healthcare Network
Agency Contact: Charity Thatcher
- Position Type: Full Time
- Job Type: Permanent
- County: Cass
- Salary Range: 79,000 - 101,000 per Year
- Send applications to: firstname.lastname@example.org
- Please include your resume when applying.
QUALITY/UTILIZATION DIRECTOR – POSITION OVERVIEW:
This position will work closely with staff at all levels (including management, clerical, direct care, and Board members) and across all counties to ensure that consumers are provided services in the most efficient and cost-effective manner consistent with quality standards, person centered planning, and medical necessity. This position will also function as the primary contact for all regulatory and accreditation organizations.
• Mental Health Professional who has masters level license and/or certifications with a scope of practice to the clinical area that is the subject of the clinical review.
• A valid driver’s license if transporting or utilizing agency vehicles.
• Sound understanding of management processes relative to organizing, planning, implementing, and evaluating along with strong oral and written communication skills.
• Access to reliable transportation
Any combination of education, training and experience providing the required knowledge, skills, and abilities to perform the essential functions of the job will be considered.
REQUIRED SKILLS & ABILITIES
• Experience in a CMHSP setting.
• Excellent verbal and written communications skills
• Working knowledge of Microsoft Windows including Word, Excel, Outlook, PowerPoint, and Teams applications
• Ability to effectively organize and prioritize work assignments.
• Ability to effectively interact with various teams within WBHN as well as external organizations.
• Review service delivery to assure the availability, quality, and accessibility of services.
• Monitor a broad spectrum of system activity to ensure that consumers are provided services in the most efficient and cost-effective manner consistent with quality standards, person centered planning, and medical necessity.
• Participate in the planning and implementation of the annual strategic planning as assigned.
• Coordinate services with other CMH professional staff, programs, or agencies as needed.
• Complete utilization review functions for the agency.
• Chair WBHN Quality Improvement Committee.
• Assist in developing program outcomes and monitoring of such.
• Perform supervisory functions such as participating in the evaluating performance for credentialing purposes, counseling employees, training, organizing service delivery, rewriting, or writing clinical directives regarding documentation and service delivery, and establishing practices that conform to regulatory standards.
• Prepare regular reports as required and special reports when requested.
• Assists the agency in meeting standards for program quality, as appropriate, as issued by regulatory agencies including the Department of Community Health, CARF, Medicaid and through the Balanced Budget Act.
• Participate in Regional Utilization Management Committee.
• Review authorization requests for medical necessity/clinical appropriateness; documentation completeness
• Review WBHN Non-Medicaid report monthly and provide email feedback to assigned clinician and supervisor. Update Level of Care for those consumers who are General Fund Consumers.
• Conduct specific Service activity reviews as necessary.
• Participate in appeal hearings as relevant to authorization process.
• Review Specialized Residential requests obtained from clinician for medical necessity.
• Be knowledgeable about and actively support 1) culturally competent, recovery-based practices, 2) person-centered planning as a shared decision-making process with the individual, who defines his or her own life goals and is assisted in developing a unique path toward those goals, 3) a trauma informed culture of safety to aid consumers in their recovery process.
• Adhere to all policies, procedures and/or legal commitments to the recipients as required by WBHN, all licensing regulatory agencies, and department rules.
• Participate in staff meetings, in-services, required training, special meetings, continuous quality improvement process and committees as required.
• Other duties as assigned.
COMPENSATION AND WORK SCHEDULE
This is a full-time, salaried position with additional benefits. The salary is level C on the Woodlands Behavioral Healthcare Wage and Salary Scale. Minimum hours are 40 per week. Work is typically completed Monday through Friday; however, days and times can vary and will be set in conjunction with the Executive Director.
ENVIRONMENT & SAFETY
MINIMUM PHYSICAL REQUIREMENTS
• Exerts/lifts up to 15 pounds of force occasionally.
• Ability to sit for extended periods of time.
• Ability to travel offsite for various meetings, activities, and events.
• Ability to use computer, telephone, copy machine and other office equipment.
• Hybrid of remote and in office work
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.