Access Utilization Management Specialist

Full Time
Traverse City, MI 49684
Posted
Job description

($66,418 - $76,418)

ESSENTIAL POSITION FUNCTIONS (listing Position Specific functions first):

  • Provide essential access system functions including welcoming, screening, eligibility determination, collection of relevant information for reporting and decision-making purposes, referrals, provision of relevant consumer information and provision of outreach services when necessary.
  • Provide Customer Service, by answering questions regarding services offered, eligibility for service, benefit/insurance coverage information and/or information regarding possible complaints or concerns. Refer or assist individual to take actions to resolve questions or concerns.
  • Obtain sufficient information from individuals requesting service to determine their apparent eligibility for service including demographics, clinical assessment and diagnosis, level of care determination and referrals.
  • Provide face to face clinical assessments of potential new consumers.
  • Provide new consumer initial orientation to CMH services including Person Centered Planning process.
  • Working knowledge of external agencies and providers and ability to assist requestors of service in linking to other providers when there is a need. Follow up with individuals when appropriate and with consumer acceptance.
  • Work efficiently with other person(s) in classification to ensure requests are responded to in a timely manner.
  • Screen and address within access service any barriers to service, including speech, language and cultural needs or issues.
  • Assure that customers with Limited English Proficiency or other special needs have available and receive appropriate assistance with respect to all CMHSP services, including access to and utilization of the PIHP grievance and appeal process.
  • May participate in interventions, assessments, and other aspects of crisis services during and after hours as necessary.

SUPPLEMENTARY FUNCTIONS

  • May represent NLCMHA on internal/external committees or work groups to enhance organizational performance and development and quality of care, including Quality Improvement activities.
  • May participate in community education/community caregiver activities.
  • May receive and assist in resolving complaints or inquiries related to services provided by NLCMHA.

GENERAL PERFORMANCE RESPONSIBILITIES:

  • Set priorities and make decisions, which reflect consistency with NLCMHA’s vision and mission statements, goals, values, policies, and procedures.
  • Provide services and conduct tasks in accordance with terms/conditions required by the funding source, i.e., Northern Michigan Regional Entity (NMRE Contract), Michigan Department of Health and Human Services (MDHHS) CMHSP Master Contract and with applicable laws and regulations.
  • Participate in approved staff development activities, in-services, and supervisory sessions.
  • Maintain confidentiality and develop a trusting rapport with consumers, families/guardians, staff, and the public.
  • Behave and communicate in a manner that promotes a positive work atmosphere.
  • Perform duties in an accurate and timely manner.
  • Maintain up-to-date documentation/records/reports as applicable for position performance accountability.
  • Adjust work schedule, with supervisory approval, to meet consumer and/or NLCMHA needs.
  • Maintain an awareness to provide a safe and healthy environment and will report all hazards and/or concerns.
  • Accept other responsibilities and duties required by the supervisor, consistent with the accomplishment of NLCMHA’s goals and objectives and the functions of this position. Such responsibilities shall be incorporated into the job description if they involve a lengthy commitment of time or are ongoing.
  • Advise supervisor if actual practice (activity) begins to deviate significantly from specified essential functions.

QUALIFICATIONS & COMPETENCIES:

Credentialed by NLCMHA to provide services in this professional discipline.


MINIMUM EDUCATION & EXPERIENCE:

Master's Degree in Social Work, Clinical Psychology, or Counseling from an accredited university. Two (2) years’ experience in the mental health field with experience in working with individuals with severe and persistent mental illness and individuals with Developmental Disabilities. Demonstrated competency in the use of diagnostic skills to include the use of DSM IV. Prior experience in performing utilization review functions is highly desirable.

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