Quality and Utilization Management Director
Quality and Utilization Management Director
Join Southwest Behavioral & Health for exceptional growth opportunities driven by our promote-from-within philosophy. We provide an EXCELLENT compensation and benefits package, including immediate participation in our 403(b) program with 20% company match after 1 year of service. Generous Paid Time Off (PTO) includes 3 weeks of time-off your 1st year (available after 6 months) and increased vacation accruals after 2, 5 and 10 years of service! We offer low cost medical insurance and offer 100% company-paid dental, Short Term Disability, Long Term Disability, and Life coverage for employees. Other great benefits include 10 paid holidays, vision, licensure/certification reimbursement, tuition reimbursement, prescription drug discounts, chiropractic services, 100% paid Employee Assistance Program, and much more!
Southwest Behavioral & Health Services is a large and growing, non-profit community-based provider of behavioral health services with locations throughout the Phoenix metropolitan area, rural Maricopa County, Gila, Pinal, Mohave, Coconino, and Yavapai Counties. We are a well-established voice in the community with more than 115 sites, over seven hundred employees, and 40 years’ experience.
We are seeking a Quality and Utilization Management Director to oversee the Quality and Utilization Management programs for Southwest Behavioral Health. This position will be responsible for some direct internal auditing, training and supervising staff, and clinical quality assurance management as it relates to the quality of clinical records and regulatory/fund source documentation requirements. Ensures that policies and initiatives are efficient, meet client expectations and are updated to reflect regulatory changes. Works with internal departments to ensure positive outcomes with the highest performance standards.
This is a full-time position working 40 hours per week in our Administration Building located in Phoenix.
Duties & Responsibilities:
- Direct and lead the Quality and Utilization Management Department to support SBH's mission, strategic and operational plans, and contract performance requirements, to include direct supervision of staff within the department.
- Be a change leader to promote the development of the Quality and Utilization Management Department.
- Promote quality concepts for problem identification, investigation and resolution.
- Responsible to facilitate preparation and coordination of clinical record reviews by all regulatory agencies.
- Educates and assists department leaders and staff to maintain and follow appropriate policies, procedures and documentation to fulfill requirements and regulations.
- Demonstrates current clinical knowledge as well as current knowledge of laws, regulations and standards relating to CARF, State Health Departments and Health Plans.
- Train and supervise staff within the Q/U Management Department.
- Manage and schedule quarterly internal quality audits for all SBH programs for quality and compliance with AHCCCS, ADHS, T/RBHA, Health Plans and other funding source documentation requirements.
- Initiate audit reports and distribute to program leadership. Provide support to audited sites with the development of corrective and preventative actions addressing any significant non-compliance identified in the audits as needed. Performs collections, compilation, analysis and reporting of assigned quality and utilization metrics.
- Working under the direction of the Chief Compliance Officer, assist in the investigation of internal or external quality related events. Verify corrective and preventative actions are in place and working as part of the internal audit process.
- Analyzes, tracks, and reports general trends in documentation as relevant to compliance issues and keeps ongoing records of outcome data.
- Prepares summary reports, recommendations, and presentations to Chief Compliance Officer, SBH leadership, and other committees as needed. Works with internal departments to correct QM/UM issues.
- Collects and tracks quarterly program internal audit data.
- Communicates with T/RBHA, Health Plans and funding sources regularly to clarify documentation requirements, content, and outcomes.
- Responsible for preparing the organization for accreditation readiness and onsite surveys.
- Maintain knowledge of current and potential new/revised regulations and standards.
- Provides in-services to staff as needed on documentation as it relates to internal and external regulatory and funding source rules and regulations.
- Maintains the integrity and confidentiality of all client information.
Education & Qualifications:
- Master's Degree in Counseling, Social Worker, or a related field, plus 5 years of directly related experience required.
- Equivalent combination of education and direct experience will be considered.
- Licensed by the AZ Board of Behavioral Health Examiners at the independent or associate level preferred.
- Must have prior utilization and quality management experience.
- Expertise with project planning, team management, and new program development.
- Demonstrated successes with operational design and performance improvement projects.
- Previous experience in Health Care Administration, Management or Operations preferred.
Job Reference #: 4706