Utilization Management Coordinator
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 one thousand employees, and 40 years’ experience.
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!
We are seeking a Utilization Management Coordinator to join our Quality Management Department!
In this position your primary function will include completing internal audits related to medical management and HEDIS measures. You will analyze, track and report concerns and issues related to HEDIS measures, Gap reports and performance measure rates. You will also be responsible for active communication and coordination with members and medical providers.
Duties & Responsibilities:
- Audits clinical documentation to ensure compliance with AHCCCS, OBHL,T/RBHA, and other oversight bodies/funding source requirements in accordance with priorities set by the Chief Quality Officer and SBH leadership.
- Analyzes data and provides reports of audit outcome findings and recommendations.
- Monitors completion of corrective action set by Chief Quality Officer and SBH leadership in response to audit findings.
- Assists in the resolution of program specific compliance issues.
- Collects and tracks quarterly program audit data.
- Actively participates in external meetings with regulatory agencies.
- Communicates with SBH members to assist in ensuring medical needs are being addressed.
- Coordinates with external providers to assist member in securing appointments and addressing medical needs.
- Assists with external QM/UM review processes.
- Completes exit conferences following each audit to discuss strengths and opportunities for improvement.
- Provides training, as needed, to assist staff and supervisors with improving clinical documentation and compliance.
- Conducts NEO training to review HEDIS measures and medical management standards.
- Maintains awareness of current oversight bodies/fund source expectations with regard to HEDIS measures, medical management and clinical documentation standards.
- Conducts special evaluation studies as assigned.
- Maintains the integrity and confidentiality of all member information.
- Uses tact and sensitivity and communicates effectively with all internal and external customers including but not limited to: SBH members and personnel, funding sources, regulatory agencies and external providers.
- Assists with developing technical assistance resources to allow SBH employees to gain a better understanding of HEDIS measures and medical management practice.
Education & Qualifications:
- Bachelor’s Degree in Behavioral Health, Nursing or directly related field, plus 2 years of directly related experience required; or equivalent combination of education and direct experience (1 year college = 1 year experience).