Job: Coordinator of Quality Management/Utilization Manager (RURAL SERVICES)

POSITION SUMMARY:
Under the supervision of the rural Regional Director and working closely with the Director of Quality Management, performs internal audits, evaluates, and recommends improvements for the quality of behavioral health services provided by Pantano and its service providers Cochise and Santa Cruz Counties.

SPECIFIC RESPONSIBILITIES – QUALITY MANAGEMENT
•Monitors and evaluates the overall quality of behavioral health services provided by Pantano and its contracted service Providers to ensure compliance with CPSA contracts, state legislation, AHCCCS, and ADHS/DBHS regulations.
•Coordinates annual Agency ADHS/DBHS licensure.
•Reviews and processes critical incidents and sentinel events for members. Ensures that appropriate follow-up care is provided when necessary and forwards appropriate information to Director of QM.
•Coordinates with Pantano Central on periodic Joint Site Reviews and annual Provider Profiles to review charts, prepare reports of findings, and recommend improvement activities. Collects and evaluates data for feedback to Providers.
•Identifies performance improvement opportunities at the Network and Provider level. Coordinates, monitors, evaluates, and reports on the design and implementation of improvement activities.
•Provides technical assistance to Providers. Oversees the dissemination of new policies and requirements to Providers.
•Coordinates, tracks, and monitors credentialing and re-credentialing for: Initial Assessment Staff, LIP’s, Clinical Liaisons, and Specialty Providers. Tracks competencies from Providers on all BHP and BHT staff.
•Reviews agency policies, procedures, and staff training competencies on an annual basis for compliance to standards. Recommends revision of Agency and Provider policies and procedures as needed.
•Prepares regular reports for CPSA, Pantano Director of QM, Pantano CEO, and Board of Directors.
•Working with the Director of QM, helps to write and implement annual Quality Management Plan and QM Workplan. Oversees the development of a network-wide Training Plan.
•Directly supervises the Medical Records Department.
•Participates in the QM Committee, Quality Council, Clinical Review Team, Management and Administrative Meetings, and the CPSA QM Coordinator meetings through teleconferencing or in person when possible.
•Participates in agency functional committees, such as Risk Management, Safety, Environment of Care, and Training through teleconferencing or in person when possible.
•Coordinates with Pantano Central in collecting, evaluating and distributing Cultural Competency data for CPSA and Providers to utilize for performance improvement initiatives.
•Collects, evaluates, and distributes Member, Staff, and Provider Satisfaction data for CPSA and Providers to also utilize.
•In collaboration with the Intake Department, monitors Referral to Intake, Intake to First Service and Referral to First Service.
•Completes Coordination of Benefits reports to AHCCCS, CPSA and Pantano.
•Completes other general reports related to GSA 3 Pantano activities as requested.
•Performs other Quality Management duties as appropriate.

SPECIFIC RESPONSIBILITIES – UTILIZATION REVIEW
•Acts as the UM liaison with Pantano Central, attending UM meetings through teleconference or in person when possible and disseminating information to appropriate staff.
•In conjunction with the Quality Management Department and Pantano Central maintains a written Utilization Management Plan, with related Policies and Procedures, which meet State and Federal requirements.
•Reviews the scope, objectives, organization and effectiveness of the Utilization Management Plan annually, and revises as necessary.
•Responds to Pantano Central or CPSA queries on UM activities and needed data.
•Performs other duties as assigned.
•Participates in Pantano’s Care Management Review process.
•Performs other duties related to Utilization Management and Review as appropriate.

Education* & Experience:
•College Degree in a related field
•Experience in quality management

*Only degrees from an accredited college or university recognized by the Department of Education are acceptable to meet positive education requirements or to substitute education for experience. For additional information, please go to the U.S. Department of Education websites at http://www.ed.gov/admins/finaid/accred/index.html

General:
•Demonstrates technical, administrative, managerial, supervisory, knowledge
•Ability to operate personal computer and telephonic communications equipment
•Ability to read handwritten and printed documents and records
•Ability to perform analysis of information
•Ability to communicate clinical matters verbally and in writing
•Demonstrates knowledge of growth and development across the lifespan as these relate to populations served (i.e. children, adolescents, adults, geriatric); Recognizes age-specific and/or population specific responses to treatment as related to the populations served (children, general mental health, persons with SMI, substance use/abuse)
•Able to evaluate the adequacy and sufficiency of a comprehensive mental health or substance abuse assessment.
•Demonstrates knowledge of Utilization Review &/or Quality Management policies and practices.
•Excellent oral and written communication- must speak clearly and persuasively in positive or negative situations.
•Must be at least 21 years of age and able to obtain a Class I Fingerprint Card.