QM/UM Specialist

CHANGEPOINT INTEGRATED HEALTH

JOB DESCRIPTION

TITLE:  QUALITY MANAGEMENT/UTILIZATION MANAGEMENT SPECIALIST  (QM/UM SPECIALIST)

STATUS:  NON-EXEMPT

LINES OF AUTHORITY: This position is supervised by the Director of Quality Management.  This position does not supervise staff but works collaboratively with supervisors to provide feedback regarding utilization management for the hospital, quality management and clinical record information for ChangePoint Integrated Health.

POSITION SUMMARY: This position is responsible for conducting record reviews for monitoring compliance with regulatory agencies and assisting in with the monitoring of the hospital's QM Plan, UM Plan, and ChangePoint's QM Plan at the direction of the Director of Quality Management. 

PRINCIPLE DUTIES/RESPONSIBILITIES:

  1.  Adhere to personnel policy and comply with agency requirements for ethical

  and professional behavior.

2.  Participate in the implementation of the QM System, and assist in the

  development of the annual Evaluation and Plan.

3.  Participate in the implementation of the hospital's QM and UM system, and

  assist in the development of the annual Evaluation  and Plan.

 4.  Assist in the development and revision of policies and procedures as 

  needed.

  5.  Be a resource to clinicians and other administrative staff in regards to basic

  regulatory record standards including OBHL, ADHS/DBHS, HCIC, TJC, AHCCCS, Medicare.

  6.  Able to produce verbal and written reports, and visual graphs to reflect data  analysis.

  7.  Work as team player assisting staff with various skill levels and backgrounds to understand and comply with record standards.

   8. Must be accurate, efficient and complete in documentation.

   9. This position requires positive and active support of the company,

  Patients, families and co-workers.

  10. Must participate in quality management and quality improvement activities.

  11. Promotes quality and safety to help maintain a safe and pleasant work

  environment, follows safety regulations, and actively contributes towards a

  safe workplace.

  12.  Perform other duties as assigned by supervisor.

PRIMARY CONTACTS:

Regular review of clinical records (electronic and written). 

Interface regularly with Director of Clinical Operations, Hospital Administrator Medical Director, Director of Quality Management and other supervisors.

Periodic interface with regulatory and accrediting bodies/employees.

POSITION REQUISITES:

  Qualifications And Experience

  Required: 

High School Diploma

Current Arizona Driver's License.

One year experience working for a behavioral health agency.   

Comply with a Drug Free workplace.

Fingerprint Clearance.

  Skills/Abilities

  Required:

  • Able to work within a multi disciplinary structure.

  • Able to employ Quality Management theory and techniques.

  • Strong verbal and written communications skills.

  • Basic knowledge of resources related to regulations.

  • Strong organizational and time management skills.

  • Able to interact effectively with supervisors and employees.

  • Fluent in English both verbally and in writing. 

  • Literate.

  • Able to effectively employ analytical and problem-solving skills.

  • Ability to work forty (40) hours per week.

  • Able to use various computer software programs to produce high quality report and graphs, tables.

  WORKING CONDITIONS:

  Physical Requirements

  • Able to sit and stand for extended periods of time, less frequently, walking, lifting

  and reaching.

  • Able to hear ordinary conversation and phone communications.

  • Visual capacity necessary to fulfill documentation, responsibilities of job.

  • Negative TB skin test. 

  Emotional Capabilities

  • Able to provide verbal and written feedback, including negative feedback, to employees and supervisors related to clinical record reviews and other QM monitors.

 

  Equipment Operation

  • Able to operate general office equipment, including computers.

  • Able to operate Company vehicles.

  Environmental Conditions

  • Air conditioned and/or heated office setting.

  Accommodations(s)

  • Will accommodate as appropriate and reasonable.

CONFIDENTIALITY LEVEL:

I understand that State and Federal Laws strictly prohibit unauthorized access, use, modification, disclosure, or destruction of confidential, sensitive or protected health information.  Penalties for violation may include ChangePoint disciplinary action, including termination of employment, and/or criminal or civil action.