Utilization Management (UM) Program Manager - Brevard, Orange, Osceola and Seminole counties

Job Description

Job Description

Salary: $65,000/year

Position Summary: The UM Program Manager provides oversight and management of service authorization data validation, reporting and trend analysis related to purchased services in the ARGOS System. This position evaluates the efficiency, appropriateness, and clinical necessity of mental health, behavioral health and substance abuse treatment services provided to children and families. This includes fiscal management, forecasting and entering annual budgets, new providers, and services. This position reviews and processes provider invoices, reviews line-by-line entries, and submits to finance for payment. The UM Program Manager reconciles ARGOS Dependency Cases to FSFN for accuracy and deduplication. This position serves as the Subject Matter Expert (SME) and liaison on enhancements and modernization of the service authorization process and supports Children’s Mental Health funding through (100/806) referrals from the Clinical Coordinators. This includes processing payment of 100/806 authorizations/check requests when clinical requirements are met. This position also submits 100/806 reports to DCF and supports the finance department on supporting documentation. This position assists with completing the annual satisfaction survey of the provider network and identification of gap analysis This position provides direct supervision and support to a team of Clinical Coordinators, Fatherhood Engagement Specialist, Network Support Manager and Addictions Specialist. The UM Program Manager participates in the on-call rotation for placement as the second tier.

Technical/Functional Expectations:

1. Referrals - Essential Function: Supporting Children’s Mental Health funding through 100/806 referrals from Clinical Services Coordinators, including processing payments for 100/806 authorizations/check requests when clinical requirements are met.
2. Provider Network Directory – Essential Function: Maintaining the provider network directory.
3. Supervise and Support – Essential Function: Providing direct supervision and support to the following positions: Clinical Services Coordinators, State Opioid Response Specialist, and Peer Support Specialist.
4. SOR Program Documentation – Essential Function: Managing required documentation for the SOR program as directed by CFCHS.
5. Point of Contact – Essential Function: Serving as the Point of Contact for Early Childhood Court.
6. On-Call Rotation – Essential Function: Participating in the on-call rotation for placement as the second tier.
7. Other duties as required: Job performance requires fulfilling other incidental or related duties as assigned, assisting, and training others, and performing duties of higher rated positions from time to time for developmental purposes.
8. Application utilization – Essential Function : Analyzes current system capabilities/processes, to implement content management (CM) modifications to help end-users.
9. Data Analysis – Essential Function : Synthesizes data, creates reports, and monitors performance through historical or trend analysis.
10. Process and Procedure to Standard Maintenance – Essential Function : Uses statistical data methods to monitor and chart utilization of services by provider as well as notifying appropriate managers of non - compliance of providers to maintain quality services for our customers.
11. Quality Service Standards – Essential Function: Creates meaningful relationships with all partners within the System of Care to maintain and improve the delivery of quality services.
12. Reports Preparation – Essential Function: Collect, analyze, and summarize data within the Utilization Management System to prepare reports for users, and other stakeholders.
13. Proficient use of Computer Applications – Essential Function: must be able to work with other computer applications throughout the agency to assist in analysis, data collection, and reporting of data to enhance our quality improvement process.
14. Other duties as required: Job performance requires fulfilling other incidental or related duties as assigned, assisting, and training others, and performing duties of higher rated positions from time to time for developmental purposes.

Behavioral Competencies:

1. Facilitation: Able to use judgment and provide a process to ease group resolution of issues; clarify points of view and terminology to gain group acceptance; facilitate the actions, decisions, or opinions of others in a positive direction.
2. Develop Relationships: Able to relate with others while building credibility and rapport; give personal support and reassurance; put others at ease; build cooperative relationships.
3. Responsiveness: Able to take action to meet the needs of others; respond to solve problems; minimize delays or problems with little or no supervision.
4. Verbal Communication: Able to clearly express ideas, information, or concerns with the spoken word; present verbal information in a straightforward manner; ask questions to open channels of communication; listen to understand the perspective of others.
5. Problem Solving: Able to exercise judgment in building realistic solutions to problems; understand the genuine issues behind problems, use common sense and take practical action to solve problems.
6. Integrity: Able to demonstrate consistency of words and actions; protect confidential information; do what is right even when no one is watching; demonstrate sound business ethics; consistently comply with organizational values.
7. Sensitivity: Work effectively with and show sensitivity to cultural differences and various socio-economic backgrounds of others.
8. Ethics: Adhere to and model principles and values of Agency and System of Care by being strength-based, solution-focused, maintains highest level of integrity and ethical standards and collaborate with employees, partners, stakeholders, and clients in all interactions.

Business Experience:

1. Two years’ experience in Budgeting and Fiscal Management: This is required to provide sound oversight of the service allocation budget ensuring the maximization of resources.
2. Two years supervisory experience.
3. Minimum five (5) years prior Child Welfare Experience: To effectively understand the integration of various system components, statute and administrative code governing the delivery of services to at risk children and their families.
4. Minimum two (2) years Clinical Experience: This is required to effectively supervise and coach clinical service options and support
5. Valid Driver's License-Essential: This position requires a valid driver’s license to travel throughout the County.
6. Computer skills (Microsoft and Web based application): This position uses Microsoft and a web-based application for daily entry of case activity and the utilization management of service authorizations.

Educational and Experience Requirements:

1. MA/MS - master’s degree Counseling/Psychology or Social Work required.
2. Child Welfare Certified by Florida Certification Board required.

Physical Requirements:

1. 90 % Sitting
2. 10 % Standing
3. 50 % Reading
4. 30 % Speaking
5. 10 % Writing
6. Listening
7. Near Acuity
8. Typing

Family Partnerships of Central Florida is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status. These employers also maintain Drug-Free Workplaces. Requests for Auxiliary Aids for Hearing Impaired or Limited English Proficiency Candidates may be made with a minimum of five (5) days notice to C. Hernandez at (321) 752-4650.