Job Details
Job Location
Plano, TX
Position Type
Full Time
Education Level
Graduate Degree
Salary Range
$ Salary/year
Description
The Program Administrator of Utilization Management works with all behavioral health staff through Directors, other BH Program Administrators, and Compliance and Quality Assurance to advance the agency efforts in Utilization Management. The position is supervised by and acts on assignments from the Deputy Clinical Officer. As Program Administrator of Utilization Management, responsibilities include facilitating fact-based decision making supported by timely, accurate and relevant information and data on operations, providers, and individuals receiving services. The position fills the roll of the UM Director as defined in the HHSC/DSHS contract and oversees compliance with HHSC contracts and UM guidelines. This position requires management of budgets, supervision of staff at various professional levels, and will provide backup/support for UM team. This position requires innovation and investigation in quality and utilization oversight. This position is responsible for responding to and resolving questions and complaints from individuals/families, contractors, and stakeholders.
The Program Administrator of Utilization Management oversees the UM Committee and ensures meeting occurs, at minimum, quarterly to review thorough data trends as well as provide recommendations to improve processes and efficiencies. The Program Administrator of Utilization Management coordinates provider meetings, at minimum, monthly unless otherwise documented accordingly based on data demonstrating appropriate utilization of funds and performance targets. This position demonstrates effective communication verbally and in writing, presents data through charts and graphs, and facilitates appropriate training based on data trends if necessary. This position oversees all Behavioral Health UM Managers and UM technical support specialists. This position works collaboratively to advance the effectiveness, efficiency, and achievement of high clinical standards in all areas of the BH services. The Director of Utilization Management does not provide direct BH services, nor does the position supervise direct service providers.
Qualifications
Education, Training and Experience (including licensure and certification)
• Master's Degree in Psychology, Counseling, Social Work, or Related Field required.
• Fully licensed as LPC, LCSW, or LMFT required. Supervisor status highly preferred.
• 5 years' experience in the treatment of individuals with mental illness or chemical dependence required.
• 3 years' experience in a supervisory role required.
• 3 years' experience in the role of utilization and/or quality management required.
• Experience in the management of budgets, design of processes and systems for delivering community-based services, and
coordination with a large management structure and stakeholder groups highly preferred.
• Experience working in a Certified Community Behavioral Health Clinic (CCBHC) highly preferred.
Knowledge, Skills, and Abilities
• Comprehensive knowledge of Texas Administrative Codes that relates to Mental Health Community Centers, Info Item V
Standards, and UM guidelines.
• Full understanding of continuum of care options, least restrictive environment, and medical necessity.
• Comprehensive knowledge of mental health diagnoses, recovery-oriented practices, crisis procedures psychotropic
medications, and clinical processes.
• Skilled at working with a variety of staff to develop efficient and effective systems for providing quality services and the
appropriate training to implement and monitor these processes.
• Able to communicate effectively verbally and in writing; understand and synthesize a wide range of information; use computer
technology effectively for management information purposes; develop reports and other forms of communication for a variety of
audiences and purposes.
• Able to delegate tasks appropriately amongst team members for operational excellence.
• Able to deal with individuals and families in a compassionate and professional manner to resolve complaints.
• Ability to work effectively within a complex management structure.
• Able to exercise constant flexibility and adaptability to accommodate the complex nature of community behavioral health
services.
• Demonstrated ability to ensure effective communication regarding QM and UM operations, performance, and problems.
• Works under general supervision with moderate latitude for the use of initiative and independent judgment.
• Knowledge of the social services system and the ability to guide staff in connecting individuals with appropriate services.
• Organized, detail oriented, computer proficient, and able to write clearly and professionally.
• Ability to respond to individuals with patience, empathy, and understanding.
