Utilization Management Specialist

General Purpose of Job

To act as a liaison between the Case Management Organizations (CMOs), the Department of Children & Families (DCF) and specialty and/or community providers to facilitate identification of service needs and provision of appropriate and timely services to children and families with the goal of moving cases toward permanency. The UM specialist takes a primary role in ensuring the effective management of allocated resources.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Duties and Responsibilities

• Prepare initial authorization of paid, purchased, and contracted and Medicaid funded services funded by the Lead Agency ensuring that authorizations are generated quickly to facilitate initiation of services to children and families.
• Works with the Point of Contact (POC) to serve as the central point of contact for case managers in referring children for Comprehensive Behavioral Assessments (CBAs), other behavioral assessments as needed and mental health services.
• Process and track the progress of Comprehensive Behavioral Health Assessment (CBHA) referrals. Receive completed assessments and process service authorizations once approved.
• Cultivates effective communications and working relationships with network of service providers.
• Maintain accurate client records of service requests, authorizations, and payments processed.
• Evaluate and process flex fund and community development requests.
• Track process of referrals for Suitability Assessments (QE), adherence to time frames, including level of care; admit dates, changes in level of care, name of therapeutic providers.
• Processes invoices from providers for payments.
• Work together as a team with co-workers to streamline processes and maintain unit efficiency and quality of work.
• Monitors email on daily basis. Circulate pertinent information to unit staff members.
• Maintain regular in-office attendance when not performing required field-based duties in order to carry out essential job functions, collaborate effectively with team members, participate in meetings with internal and external stakeholders, access agency resources and systems, and provide timely support for agency operations and service delivery.
• Must be able to drive and have reliable transportation to perform required field based activities
• Perform other duties as assigned to support departmental and agency goals, as needed and appropriate to the position.

Working Hours

Children’s Network of Hillsborough’s standard business hours are 8:00 a.m. to 5:00 p.m., Monday through Friday. This position is an in-office based position with fieldwork requirements, that averages 40 hours per week. Work hours may vary outside of these standard hours, including evenings and weekends, as needed to meet operational demands. All hours worked will be compensated in accordance with the Fair Labor Standards Act (FLSA) and agency policies, including applicable overtime and other compensation requirements.

Travel

Travel within and outside of Hillsborough County is required. The employee must be able to drive and have reliable transportation to perform the essential functions of the position.

Training

All employees are required to complete fifteen (15) hours of training annually, which may be completed online or in a classroom setting. Employees who hold a credential or license relevant to their position must ensure that all training and continuing education requirements are met to maintain their credential or licensure

Supervisory Responsibilities

This position does not have supervisory responsibilities