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MHSU Utilization Management Manager

Company: Vaya Health
Location: Asheville
Posted on: January 26, 2023

Job Description:

GENERAL STATEMENT OF JOB:The MHSU UM Manager is responsible for supervision of the MHSU Utilization Clinicians and Care Reviewers who directly provide utilization review services. Manage the team's workload and ensures appropriate utilization review decisions are rendered consistently and timely. Ensure principles of Whole Person Care are incorporated in team procedures and training. In collaboration with the UM Clinical Director, responsible for recruiting, selecting, training staff, and ensures that the team follows departmental policies and procedures. The MHSU UM Manager works closely with other key leadership, including the Chief Medical Officer, to ensure consistent, appropriate review of Medicaid and State-funded services. ESSENTIAL JOB FUNCTIONS:Supervision, Assessment/Evaluation and Collaboration

  • Manage the daily operations of the MHSU UM team of the Utilization Management and Review Department.
  • Provide departmental technical assistance related to processing requests.
  • Recruit hire and train UM staff in consultation with the UM Clinical Director.
  • Track and monitor authorization, Person-Centered Plans (PCP) and assessment submissions including volume, deficiency patterns and timeliness of reviews.
  • Monitor team performance, provide feedback, coaching, and supervision. Report performance metrics to the UM Clinical Director.
  • Participate in state level or accreditation audits and preparation of reports or documentation as requested.
  • Review service authorization requests (SARS) for medical necessity.
  • Render authorization determinations and complete administrative reviews.
  • Ensure complete documentation of review and determinations, including adverse determinations requiring sending written notices.
  • Conduct monitoring of high-risk, high-cost individuals' services between authorizations as indicated.
  • Consult with and educate providers about MCO authorization requirements, evidence-based practices, and other components of quality service provision. Provide informal training. MHSU Utilization Management Support
    • Identify and document service gaps and deficiencies in access to services.
    • Consult providers and internal staff regarding complex, high-risk cases.
    • Collaborate with Vaya UM and Care Coordination staff to improve services to high risk, complex members, and those without a Clinical Home.
    • Participate in internal and external meetings, cross functional teams, committees, and Workgroups as requested by the UM Clinical Director. QUALIFICATIONS & CREDENTIALING REQUIREMENTS: Master's degree in Human Services field with clinical licensure. Four years of post-degree progressive experience providing services to the population served. Experience in an UM environment in Behavioral Healthcare is required. Experience providing mental health, substance use, and/or developmental disability services are essential. Experience in the public mental health field is highly desired due to the complexity of the work of the organization. LICENSURE/CERTIFICATION REQUIREMENTUnrestricted and valid licensure or certification in North Carolina as a Master's Level Clinician (i.e., LCSW, LCMHC, LPA or LFMT). PHYSICAL REQUIREMENTS:
      • Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
      • Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.
      • Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
      • Mental concentration is required in all aspects of work.
        • Knowledge of behavioral health principles, techniques, and practices, and their application to complex treatment and service provision
        • Knowledge of person-centered and recovery philosophies and interventions
        • Knowledge of assessments and interventions for mental health, developmental disability and substance use disorders
        • Knowledge of the laws, regulation, and policies which govern the services and UM
        • Ability to engage providers in collegial discussion about plans of care and best clinical practices for members
        • Ability to interact professionally and effectively with persons who are upset and who disagree with UM decisions
        • Ability to establish and maintain effective working relationships with members and their families as well as a civic, legal, medical, social, and religious stakeholders
        • Ability to express ideas clearly and concisely orally and in writing, and to plan and execute work effectively and efficiently
        • Ability to utilize complex telephone and computer systems, and to read and document information electronically. RESIDENCY REQUIREMENTS:The person in this position IS required to reside in North Carolina or within 40 miles of the NC border.
          SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.
          DEADLINE FOR APPLICATION: Open until filled
          APPLY: Vaya Health accepts online applications in our Career Center, please visit Ind.00 1
          Vaya Health is an equal opportunity employer.

Keywords: Vaya Health, Asheville , MHSU Utilization Management Manager, Executive , Asheville, North Carolina

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