What are the responsibilities and job description for the QI/UM Specialist II position at The Guidance Center?
Description
As a recognized leader in our field, The Guidance Center provides a broad range of services that have helped children, adults and families unlock potential and build better lives for more than 60 years. With 25 programs we offer treatment, prevention, growth and education services to more than 23,000 people annually. Together we: Nurture development. Foster resilience. Cultivate well-being.
We have an exciting opportunity for a Quality/Utilization Specialist II to join our team of talented professionals.
The position of Quality/Utilization Specialist II is responsible for providing peer based technical support regarding documentation, conducting qualitative and quantitative review of chart documentation and individual program procedures to ensure compliance with Joint Commission, DWIHN, CCBHC, Medicare, Medicaid, and third party payers. Independent coordination of the psychiatric peer review process, including the aggregation and reporting of the finding of these reviews, provides authorization support, oversees the general fund authorization process and monitors and reports on hospitalizations/recidivism. Facilitates and coordinates interdisciplinary case conferences of high risk and resource-utilizing clients to improve care and outcomes. Regular schedule: 8:30 to 5:00 Monday through Friday although additional hours may be necessary due to program need.
The Guidance Center believes that our team members are our most valuable resources, and we invest in them accordingly. We offer our employees a competitive salary, health/dental/vision benefits, 401(k), Life Insurance, a generous paid time off package, flexible scheduling opportunities, a team-oriented work environment and much more!
The Guidance Center is an Equal Employment Opportunity Employer.
Requirements
To qualify for this position, you will need:
- Masters Degree in Behavioral Health field
- 2 years working in the Behavioral Health field.
- Must have previous experience in clinical record documentation review. Experience with client record signoff preferred.
- Must have some working knowledge of quality improvement and record documentation principals.
- Must be able to work independently to collect, interpret, and analyze clinical data.
- Must have working knowledge of confidentiality of information principals, The Michigan Mental Health Code, Federal Regulations on Confidentiality of Substance Abuse Records, and HIPAA.
- Must have the ability to work independently.
- Additional requirements include a nonjudgmental approach that reflects cultural competency and sensitivity to the unique needs and diverse experiences of our staff members and the programs they represent.
- Experience with an electronic medical record such as PCE.
- Working knowledge of Excel and SPSS statistical software is desired.
- Detail oriented.
- Ability to collect, analyze and interpret clinical as well as non-clinical data.
