Utilization Management Coordinator

Job Description

Job Description

The Utilization Management Coordinator is responsible for performing retrospective monitoring and audit functions relative to WMCMH utilization management processes/systems. The Utilization Management Coordinator will monitor and audit the effectiveness of the WMCMH Utilization Management processes/systems, provide data to support organizational utilization decision-making, facilitate the WMCMH Utilization Management Committee and be an active participant in the Lakeshore Regional Entity UM ROAT and other regional and state UM workgroups/committees as appropriate.

The Utilization Management Coordinator will be housed on the Operations Team and will work very closely with other members of the organization.

JOB DUTIES:

1. Utilization Management – Through retrospective review and use of both strong QI principles and strong data aggregation and analysis skills, the Utilization Management Coordinator will:
   • Perform monitoring and audit functions (objective examination) relative to utilization management and/or effectiveness of WM utilization management (i.e., size and composition and accessibility of WM network; appropriateness of authorization bundles; compliance with WM authorization decision guidelines; ensure presence of golden thread; ensure consistent and compliant authorization decisions and supporting documentation, etc.).
   • In response to monitoring and audit functions, facilitate the development and monitoring of performance improvement plans as appropriate.
   • Provide/Aggregate data to support the need for new programs and/or discontinuing programs that are ineffective or inefficient.
   • Provide/Aggregate data to support the need for incorporating new or discontinuing the use of evidence-based practices.
   • Provide/Aggregate data to support maintenance/updates to authorization decision guidelines.
   • Facilitate the WMCMH Utilization Management Committee
   • Participate in the Lakeshore Regional Entity UM ROAT and other state/regional UM workgroups as appropriate.

1. Back-Up Coverage - Provide limited, short-term/backup coverage for other Operations or organizational Coordinators as needed.