Career Opportunities with Easterseals Blake Foundation

 

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Quality and Utilization Management Specialist

Department: Blake Behavioral Health
Location: Tucson, AZ

General Position Description:

The Quality and Utilization Management Specialist works under the BH Quality Management and Contract Compliance Director and is responsible for ensuring Behavioral Health systems in the Agency are contract compliant regarding, credentialing, referral tracking and utilization management.

Essential Job Duties and Responsibilities:

  • Develop and ensure Quality Management throughout the Behavioral Health systems within the Agency by facilitating the ESBF Quality Management Committee.
  • Managing and monitoring credentialing/licensing for ESBF employees and facilities in accordance with RHBA and State requirements.
  • Conduct regular audits and assessment of medical health records and implementation process.
  • Submits reports and reviews in a complete, final and timely manner.
  • Monitor and track internal and external referrals to ensure timeliness guidelines.
  • Performs analysis of clinical documentation to ensure support for medical necessity and level of care compliance.
  • Represents ESBF on the RHBA Cultural Diversity Committee
  • Develops and maintains the ESBF Cultural Competency and the Document Conformance Plans
  • Any other duties as assigned.

Knowledge, Skills & Abilities:

  • Excellent verbal and interpersonal skills.
  • Excellent clinical skills.
  • Excellent organizational, time management, project management and multitasking skills.
  • Detail-oriented with well-developed problem-solving abilities.
  • Strong written and communication skills.
  • Skill in using business software and electronic health records.
  • Flexibility and ability to respond to changing priorities.
  • Capable of managing stress in a fast-paced, unpredictable, and high intensity setting.
  • Knowledge and understanding of the Arizona Behavioral Health system.
  • Familiarity with the AZ Board of Behavioral Health examiners rules for licensing.
  • Familiarity with the AHCCCS AM/PM Manual.
  • Ability to learn and monitor ESBF contracts with RHBA.
  • Ability to gather data to complete analysis.
  • Must be reliable, punctual and flexible.
  • Displays cultural sensitivity and demonstrates the ability to form constructive and collaborative working relationships with others from diverse cultural backgrounds.
  • Ability to communicate in a culturally inclusive manner and being open to other people's differences.

Ability to:

  • Travel to all service areas
  • Work well on a cross-functional team.
  • Demonstrate professional judgement and sound decision-making skills.
  • Manage multiple priorities in a fast-paced dynamic environment.
  • Understand system logic to determine true impact of data results.
  • Complete RHBA training requirements.
  • Work independently.

Minimum Requirements:

  • Master's degree in a behavioral health related field; or Bachelor's degree in behavioral health related field and four years behavioral health work experience.
  • Extensive knowledge of managed care systems, AHCCCS/Title XIX medical assistance screening, and RBHA/DBHS policies and practices.
  • Operational experience in clinical quality/process improvements or redesign, performance measurement, health information technology, evidence-based practice guidelines and facilitation, and knowledge of Integrated Behavioral Health Care.
  • Must be at least 21 years of age and able to obtain a Level One Fingerprint Clearance Card.
  • Valid Arizona driver's license and the willingness to use personal vehicle in the course of employment. Must meet minimum requirements of agency insurance carrier.
  • Must be able to meet training and agency compliance requirements for the position.
  • Spanish speaking preferred.
  • Must be able to utilize Personal Protective Equipment (PPE), such as face mask, gown, goggles and gloves, for any amount of time necessary to provide a physical barrier to protect the employee and others.

Working Conditions:

  • Primarily works in an office environment.
  • Work hours may occasionally include evenings and weekends.
  • May occasionally be away overnight for work related functions and trainings.

Additional Information: 

This job description is not intended to be an exhaustive list of all possible duties, responsibilities and/or qualifications.   Other duties, responsibilities and/or qualifications may be assigned to this position.

Easterseals Blake Foundation is an Equal Opportunity Employer
It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the Employer's service if I have been employed. I give the Employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Employer and its representatives for seeking such information, and all other persons, corporations, or organizations for furnishing such information. I hereby consent to and authorize Easterseals Blake Foundation to request, receive and use information as often as necessary as deemed by Easterseals Blake Foundation by consumer reporting agency bearing on my credit standing, character, general reputation, personal characteristics, and mode of living, including, but not limited to, my criminal background or lack of criminal background. I authorize the use by Easterseals Blake Foundation of the original or photocopy of this authorization. The Employer is an Equal Opportunity Employer. The Employer does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state, or federal law. I understand that just as I am free to resign at any time, the Employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary.

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