Quality Assurance Utilization Manager
Quality Assurance Utilization Manager
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Job Description
Job Description
Salt Lake CountyA career with a purpose in the community you love!
Salt Lake County invites you to explore our exciting career opportunities. We seek highly enthusiastic individuals to enrich our County with your experience and talent. If you enjoy working in a team environment that is committed to changing the lives of its community please keep reading.
What it is like to work here:
At Salt Lake County our culture is woven into all aspects of our work and our employees lives from the way we treat each other to the way we support the community. To promote and foster a fun and healthy work environment we appreciate employees through great benefits a healthy work life balance and room to grow and develop.
Surround yourself with:
Peers who are motivated to make a difference in the lives of those we serve. We serve Salt Lake County and envision a safe and beautiful place for all to live work and have fun. Salt Lake County is about connecting people and championing our community. Community is more than a place.its our heart and service that bring us together.
We encourage a work life balance:
Working for Salt Lake County is more than just a paycheck. A career with /Salt Lake County includes several benefits and perks. We support our employees with 12 Holidays up to 24 vacation days 12 sick days and one personal day every year.
Additional Benefits include:
- Retirement options for hybrid pension/401(k) or 401(k) only with a 10 contribution
- Medical coverage including a 100 county paid premium optionDental and Vision coverage including coverage for adult designees
- Health Savings account with a county contribution up to $1200/year Flexible Spending Account
- 100 countypaid LongTerm Disability and ShortTerm Disability option
- Professional Development including professional membership fees paid
- Tuition Reimbursement
- Plus: Onsite medical clinic and gym; pet insurance auto and home insurance and discounts at County facilities.
For Benefits information Click HERE
To estimate how much your pay and benefits could be worth use our Total Rewards Estimator
JOB SUMMARY
Provides supervision and oversight of the Quality Assurance and Case Management teams. Provides oversight and implementation of auditing processes to ensure adherence to local area contracts and utilization of Best Practices. Manages and directs the appeals process for the Medicaid contract(s).
MINIMUM QUALIFICATIONS
Masters degree from an accredited college or university in Social Work Psychology Marriage and Family Therapy Ed. Psychology or other closely related field plus two 2 years of related experience of which one 1 year must have been in a supervisory capacity. Education may not be substituted for the required supervisory experience.
Licensed in the State of Utah as a Licensed Mental Health Professional (LCSW CMHC or LMFT).
Preference may be given to applicants having experience in substance use disorder and/or mental health treatment with experience using an electronic medical record.
Due to the nature of this position the successful applicant must pass a required background check through fingerprinting and enrollment in the continuous RAP Back (Record of Arrest and Prosecution Back) program in accordance with current County Human Resources policy requirements.
A valid Drivers License accepted by the State of Utah is required at the time of hire. A valid Drivers License issued by the State of Utah must be obtained within six 6 months of hire to operate a County vehicle.
ESSENTIAL FUNCTIONS
- Leads and directs the quality assurance auditing processes ensuring compliance with the agency contract(s) and adherence to Clinical Best Practices Standards.
- Supervises staff including hiring orienting training assigning and reviewing work performance annual work performance appraisals and discipline.
- Develops documents to assist reviewers in the auditing process.
- Performs and directs the annual audit of the contracted managed care organization (MCO) for compliance with the agencys contracts Clinical Best Practice Standards and Utah Department of Health Medicaid standards.
- Compiles and submits the annual report of summations from the site visits as part of the auditing process.
- Provides followup on corrective or improvement actions as a result of the audit.
- Monitors contracted treatment program compliance with the agencys contracts Clinical Best Practice Standards and Utah Department of Professional Licensing (DOPL) Scope of Practice regulations. Evaluates clinical documentation to ensure conformity with local area contracts and best practices standards.
- Provides oversight and supervision of the utilization review process and ensures compliance with the utilization review policy.
- Monitors clinical documentation to ensure that clients receive clinically appropriate services.
- Directs and oversees the Medicaid Appeals process.
- Completes independent reviews of mental health and/or substance use disorder treatment records submitted with appeals to determine the medical necessity of services rendered.
- Collaborates and coordinates with direct service providers on behalf of the Division.
- Acts on behalf of the agency with the Utah Department of Health Division of Medicaid and Health Financing Office of Formal Hearings.
- Assists staff in facilitating close collaboration with the agencys treatment contractors the contracted MCO County agencies and community partners.
- Provides training and technical assistance to local contracted treatment providers on utilization of the Countys electronic health record and documentation methods.
- Provides training specific to personcentered treatment planning suicide prevention and/or the American Society of Addiction Medicine (ASAM) placement criteria.
KNOWLEDGE SKILLS AND ABILITIES (KSA)
Knowledge of:
- Medicaid rules and regulations regarding the Prepaid Mental Health Plan (PMHP)
- Current State Division of Substance Abuse and Mental Health preferred practice standards
- Principles and techniques of management and supervision
- Mental health and substance use disorders treatment and prevention theory and practice
- Individual family and community dynamics regarding mental health and substance use disorders
- Utilization management techniques including case rate purchasing of services
- Records retention policies and procedures
- Federal confidentiality regulations
- Alcohol and drug abuse prevention and treatment continuum in Salt Lake County
- Fiscal management and grant writing
- Health care benefit plans managed care organizations and marketing to private health organizations
- Theories practices and training techniques in learning research and program evaluation
- Community organization public/media relations
Skills and Abilities to:
- Supervise train evaluate and direct the work of assigned staff
- Communicate effectively both verbally and in writing
- Interpret contractual agreements and direct operations within the scope of these agreements
- Use clinical knowledge and judgment to direct and clinically supervise Division staff
- Perform clinical and program monitoring through utilization management and auditing of treatment agencies
- Organize manage demonstrate leadership techniques and provide mentoring
- Develop and provide program and training materials
- Write communicate and speak publicly clearly and effectively
- Present effectively to groups
- Manage time efficiently
- Perform effectively in stressful situations
- Act independently
Additional Information
WORKING CONDITIONS AND PHYSICAL REQUIREMENTS
Work may include long hours sitting at a desk and computer. Hours may vary and require up to ten 10 hours a day. The position requires some traveling between County and local area provider(s) offices.
Required Experience:
Manager
Employment Type
Full-Time
