What are the responsibilities and job description for the Utilization Management Coordinator position at West Michigan Community Mental Health System?
The Utilization Management Coordinator is responsible for performing retrospective monitoring and audit functions relative to WMCMH utilization management processes/systems. The Utilization Management Coordinator will monitor and audit the effectiveness of the WMCMH Utilization Management processes/systems, provide data to support organizational utilization decision-making, facilitate the WMCMH Utilization Management Committee and be an active participant in the Lakeshore Regional Entity UM ROAT and other regional and state UM workgroups/committees as appropriate.
The Utilization Management Coordinator will be housed on the Operations Team and will work very closely with other members of the organization.
JOB DUTIES:
- Utilization Management – Through retrospective review and use of both strong QI principles and strong data aggregation and analysis skills, the Utilization Management Coordinator will:
- Perform monitoring and audit functions (objective examination) relative to utilization management and/or effectiveness of WM utilization management (i.e., size and composition and accessibility of WM network; appropriateness of authorization bundles; compliance with WM authorization decision guidelines; ensure presence of golden thread; ensure consistent and compliant authorization decisions and supporting documentation, etc.).
- In response to monitoring and audit functions, facilitate the development and monitoring of performance improvement plans as appropriate.
- Provide/Aggregate data to support the need for new programs and/or discontinuing programs that are ineffective or inefficient.
- Provide/Aggregate data to support the need for incorporating new or discontinuing the use of evidence-based practices.
- Provide/Aggregate data to support maintenance/updates to authorization decision guidelines.
- Facilitate the WMCMH Utilization Management Committee
- Participate in the Lakeshore Regional Entity UM ROAT and other state/regional UM workgroups as appropriate.
- Back-Up Coverage - Provide limited, short-term/backup coverage for other Operations or organizational Coordinators as needed.
Salary : $45,396 - $61,127