Utilization Management Specialist

Job Title


UTILIZATION MANAGEMENT SPECIALIST ("UM")


State


Florida


Program


Children's Network of Southwest Florida, LLC


Reports to


Director of Utilization Management


FLSA Status


Exempt (Salaried)


Job Description


Statement


This job description will be reviewed periodically as duties and responsibilities change with business necessity. Essential and marginal job functions are subject to modification.


Mission Statement

The Children's Network of Southwest Florida is committed to working with the community to protect children and preserve families.

General Purpose of Job

To act as a liaison between the Case Management Organizations (CMOs), the Department of Children & Families (DCF) and specialty and/or community providers in order to facilitate identification of service needs and provision of appropriate and timely services to children and families with the goal of moving cases toward permanency. The UM specialist takes a primary role in ensuring the effective management of allocated resources.


QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below 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.

Essential Duties and Responsibilities

• Prepare initial authorization of paid, purchased, and contracted and Medicaid funded services funded by the Lead Agency ensuring that authorizations are generated quickly to facilitate initiation of services to children and families.
• Works with the Point of Contact (POC) to serve as the central point of contact for case managers in referring children for Comprehensive Behavioral Assessments (CBAs), other behavioral assessments as needed and mental health services.
• Process and track the progress of Comprehensive Behavioral Health Assessment (CBHA) referrals. Receive completed assessments and process service authorizations once approved.
• Cultivates effective communications and working relationships with network of service providers.
• Maintain accurate client records of service requests, authorizations, and payments processed.
• Evaluate and process flex fund and community development requests.
• Track process of referrals for Suitability Assessments (QE), adherence to time frames, including: level of care; admit dates, changes in level of care, name of therapeutic providers.
• Processes invoices from providers for payments.
• Work together as a team with co-workers to streamline processes and maintain unit efficiency and quality of work.
• Monitors email on daily basis. Circulate pertinent information to unit staff members.
• Other duties may be assigned as special projects may be requested

Working HOurs

CNSWFL's work week is Monday through Friday, 40 hours per week. Your Supervisor will advise you of your work hours; however, business office hours are 8:00 am to 5:00 pm.

Travel

Travel in and outside of Circuit 20 (Lee, Charlotte, Collier and Hendry/Glades counties) may be required.

Training

All employees must complete fifteen (15) hours of on-line or classroom Training on an annual basis. If the employee is a Certified Child Welfare Professional, Training hours must total twenty (20) annually.

Supervisory Responsibilities

This position does not have supervisory responsibilities

Education and Experience

Bachelor's degree (B.A.) from a four-year accredited college or university; Florida Child Welfare Certification (Case Management or Investigations) is preferred.

Other Qualifications

• Minimum of one (1) year of experience in Child Welfare, social services, behavioral health care, or related field
• Excellent organizational and problem-solving skills
• Self-motivated with the ability to manage various work assignments simultaneously
• Ability to establish and maintain positive working relationships with others
• Knowledge of local community services is desired

Skills and Abilities

Must be able to operate standard modern office machinery, including fax, telephone, calculator, computer, scanner, printer, copier and mail machine. Minimum typing speed of 45 wpm; excellent word processing skills. Must be competent with Microsoft Office Suite programs, including Word, Excel, Power Point, Access, Publisher and Outlook. Must be competent with basic e-mail protocol and procedures including sending, receiving, replying, attachments, and meeting scheduling; excellent written and oral communication skills; effective listening skills; ability to work as a team member, and the ability to work in a multi-cultural environment. Must abide by the highest standards of confidentiality.

pre-employment requirements

Certificates, License, Registrations, backgrounds, drug screens, Etc.

• Valid driver's license required, with proof of insurance
• Driver's license check is a requirement
• Criminal background screening (fingerprinting) (Local Law Enforcement and FBI/FDLE)
• Drug Screening is a requirement
• Children's Network participates in E-Verify

Other Requirements

LANGUAGE SKILLS

Ability to read, analyze, and interpret common scientific and technical journals, financial reports, legal documents, and/or governmental regulations. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to write speeches and articles for publication that conform to prescribed style and format. Ability to effectively present information and respond to questions from groups of managers, clients, public groups, and/or boards of directors. Ability to speak effectively before groups of customers or employees.

MATHEMATICAL SKILLS

Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

REASONING ABILITY

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to be proactive, as well as handle problems involving several concrete variables in standardized situations.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This job requires the ability to sit for extended periods; walk; stand; use hands to finger, handle or feel; reach with hands and arms; stoop, kneel or crouch; talk and hear. This job requires visual acuity sufficient to read and to operate standard modern office machines. The employee must occasionally lift and/or move up to 25 pounds.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This is administrative work in an indoor office environment with a moderate noise level (business machines, printers, computers, telephones).

ADA: Children's Network of Southwest Florida, LLC will make reasonable accommodations in compliance with the Americans with Disabilities Act of 1990.

EEO: Children's Network of Southwest Florida, LLC does not discriminate on the basis of race, national origin, gender, religion, veteran status, or disability in employment, in provision of services, or in access to programs.

Children's Network of Southwest Florida, LLC is a Drug-Free Workplace.


All personnel must demonstrate the following capacities:

1. A commitment to empowering others to solve their own problems
2. Valuing a nurturing family as the ideal environment for a person
3. A conviction about the capacity of people to grow and change
4. The ability to establish a respectful relationship with persons served to help them gain skills and confidence
5. The ability to work collaboratively with other personnel and/or service providers or professionals
6. The capacity to maintain a helping role and to intervene appropriately to meet service goals
7. The ability to set appropriate limits
8. Safety and permanency of children

I certify that the statements above to the best of my knowledge accurately describe the duties performed and agree that I am qualified in education and skill to meet the requirements of the position. If the employee does not agree, indicate here:


Supervisor:

Date:

Employee:

Date:

Reviewing Authority:

Date:

Do Not Agree:

• Bachelor's degree (B.A.) from a four-year accredited college or university; Florida Child Welfare Certification (Case Management or Investigations) is preferred
• Minimum of one (1) year of experience in Child Welfare, social services, behavioral health care, or related field

• Must pass a Level II Background Check. For more information please click this link:
• Remember: If you are currently an employee of Children's Network of Southwest Florida, LLC, or one of our Case Management Organizations, it is necessary that you notify your current Supervisor, prior to applying.