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 Quality Manager.  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 records release and 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.  Responsible for performing chart reviews and chart audits as needed. 

  12.  Responsible for the review and release of medical records, ensuring that all  HIPPA rules and regulations are adhered to in the process. 

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

   environment, follows safety regulations, and actively contributes towards a

  safe workplace.

    14.  Perform other duties as assigned by supervisor.  

PRIMARY CONTACTS:

Regular review of clinical records (electronic and written). 

Interface regularly with Chief Operations Officer, Hospital Administrator, Medical Director, Quality Manager, Compliance Director 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.

Must be 21 years of age.

  Preferred:

BHT possessing a Bachelor's Degree or higher

Two years of experience working for a behavioral health agency.

   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.