Utilization Management Coordinator

EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law. 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 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. Back-Up Coverage – Provide limited, short-term/backup coverage for other Operations or organizational Coordinators as needed. Position Requirements Bachelor’s Degree Must have minimum of 5 years of direct experience working with individuals with severe and persistent mental illness and/or I/DD, and/or substance use disorder. Must have a minimum of 5 years demonstrated leadership skills and experience. Must have project management, meeting facilitation, and strategic decision-making skills. Must have excellent quality improvement knowledge and skills. Must have excellent data analysis and data aggregation skills. Must have excellent communication and interpersonal skills. Must possess a valid driver’s license and provide own transportation to and from meetings and activities at varying work locations including all agency locations in Lake, Mason, and Oceana Counties. Must have a strong understanding and experience with Medicaid and work in a public behavioral health system. Lived experiences with mental illness or co-occurring substance use disorders are valued. Full-Time/Part-Time Full-Time Pay Range $65,436 - $92,240 Position Utilization Management Coordinator Location Ludington This position is currently accepting applications. #J-18808-Ljbffr