QMHP Utilization Management Coordinator

Job Description

Job Description

Position Summary: 

Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patient’s treatment. Monitors the utilization of resources, risk management and quality of care for patients in accordance to established guidelines and criteria for designated setting and status

Significant Duties and Functions 

• Create and Maintain All Policies and Procedures, as well as Ensure that they are Upheld and Full fill
• Interviewing & Hiring of QMHP & Support Staff
• Training and development of all Staff (Ongoing)
• Supervise All QMHP, Support Staff, and Interns to ensure tasks are carried out in the most efficient and effective manner.
• Conduct staff work related activities such as meetings, workshops…
• Scheduling & Hosting Conferences
• Work with diverse populations 
• Assist in Conducting Community Outreach in the MC&T Service areas
• Prevention & Analyzing of problems before and as they occur 
• Assist in restructure of existing programs or develop of new ones 
• Oversee the assignment of Case Loads
• Overall Management of Programs
• Collaborate and build formal relationships with other organizations such as social services, primary care physicians, and mental health providers.  
• Maintain and Manage Organization, Staff, and Client Records
• Respond to Crisis when they occur
• Clinical Expert
• Mental health diagnosis of clients 
• Review and approve initial assessment
• Review and approve reassessments
• Update CMBHS for clinical Assessment
• Review medical record of patients who under the treatment for emotional or mental illness to ensure proper utilization of treatment resources 
• Review records for proper case documentation (Audit Notes)
• Review for medical necessity of treatment in relation to federal, state, and county regulations.
• Attend & Document Monthly Client Meetings in EMR system
• Provide Behavior and Mental Health referral for additional services 
• Discharge & Discharge planning process of clients  
• Perform other duties as required

Knowledge, Skills, and Abilities 

• Ability to handle sensitive material
• Ability to work efficiently and effectively both individually and as part of a team
• Work effectively as a team member 
• Ability to organize
• Effective oral and written communication skills 
• Well organized and adaptable
• Ability to communicate effectively and professionally, both orally and in writing
• Efficiency in computer skills

Education and Qualifications:

Meets the qualifications of a Qualified Mental Health Professional Adult (QMHP-A),