Utilization Management Manager
StarCare Specialty Health System - lubbock, TX
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Job Details Job Location System Administration--904 Avenue O - Lubbock, TX Position Type Full-time Education Level Master's Degree & LPHA (LPC, LCSW, LMFT) Salary Range $65,684.00 Salary/year Travel Percentage Local Travel/Less than 25% Job Shift Monday - Friday, 8am - 5pm Job Category Health Care Description StarCare Specialty Health System seeks to hire an experienced Licensed Practitioner of the Healing Arts (LPHA) to work alongside an outstanding Utilization Management (UM) Team as the UM Manager. Utilization Management: Utilization Management (UM) is the vehicle through which a Local Mental Health Authority (LMHA) ensures people receive quality, cost-effective services in a timely manner and in the most appropriate treatment setting. By implementing UM activities, the LMHA strives to achieve a balance between the needs and well-being of people seeking mental health services and the demand for services and availability of resources. The LMHA UM staff and the UM Committee identify and monitor patterns of over-utilization, under-utilization, and other utilization problems that compromise care or inappropriately utilize resources. Based on their findings, UM staff and the UM Committee recommend and participate in interventions to make utilization of services more effective, efficient, and consistent with contractual requirements and the local planning process. Key Responsibilities of the UM Manager: Note: The UM "Manager" is a function of the UM process and should not be confused with having supervisory responsibilities. Ensures consistent application of the Utilization Management (UM) Guidelines and process. Link: Utilization Management Guidelines and Manual | Texas Health and Human Services. Primary function is utilization management, conducting utilization review and granting and denying authorizations for all mental health levels of care (LOC) and services as part of the UM Guidelines. Ensures effective communication regarding UM operations and performance. Conducts perspective, concurrent, and retrospective reviews for authorization of LOCs/services for individuals. Conducts reviews for authorization of LOCs/services for individuals. Conducts reviews using clinical information submitted by providers, direct contact with providers, review of medical necessity records, and contact with the individual and family members when needed and appropriate. Makes initial adverse determinations and all clinical overrides and exceptions to the UM Guidelines, in consultation with the UM Director and the LMHA UM Physician when indicated. Monitors service delivery and outcomes to ensure services are not over-utilized or under-utilized. Reviews data to detect outliers and unusual patterns of utilization and recommends interventions to the UM Director. Informs individuals and providers relative to appropriate treatment alternatives and community resources. Manages appeals in a timely manner according to established procedures. Assists the UM Director with the UM Committee. The UM Committee monitors utilization of the LMHA's clinical resources to ensure they are being expended effectively and efficiently. Collaborates with other LMHA area such as Quality Management, Financial Services, and Information Systems in the use of UM data and with providers in planning interventions to improve provider practice. Participates in provider training on the UM process, monitors provider adherence to UM Guidelines, and provides consultation when needed. Ensures effective communication regarding UM operations and performance. This position can fulfill all UM functions except provide physician oversight for the LMHA UM process. Schedule: This is a full-time/exempt position scheduled Monday - Friday, 8am - 5pm, with flexibility to meet the needs of the department. While this is a remote position, the UM Manager must live in the Lubbock or surrounding area and be available to attend meetings on-site at StarCare locations. Remote status can be changed to on-site status should behaviors warrant, or position requirements change. Benefit Package: StarCare offers an expansive benefit package including, but not limited to: Company-paid medical coverage, fully funded employer contribution to HSA, company-paid life insurance, company paid hospital indemnity plan, 401k with up to 12% employer match, front loaded paid time off (PTO), thirteen (13) paid holidays, sabbatical leave, longevity augmentations, and employee referral augmentations. Qualifications Qualifications: Education/License Requirement: Licensed Practitioner of the Healing Arts (LPHA) with an unrestricted Texas license. Any of the following licenses are applicable: Registered Nurse (RN) or Advanced Practice Nurse (APN) Physician Assistant (PA) PhD Psychologist Licensed Clinical Social Worker (LCSW) Licensed Professional Counselor (LPC) Licensed Marriage & Family Therapist (LMFT) Experience: Minimum five (5) years of clinical experience in the treatment of individuals with serious and persistent mental illness (SPMI) including experience in an acute care setting. Minimum five (5) years of experience participating as a member of a treatment team that develops and monitors treatment plans for individuals with SPMI. Documented training within the past three (3) years in psychopharmacology, medical/psychiatric co-morbidity, and complications of SPMI. Minimum one (1) year of experience supervising mental health providers. Demonstrated competence in performing UM and review activities. Additional Requirements: CANS/ANSA Certifications, preferred. Must pass a pre-hire drug screen and criminal background check. Must have a Texas driver's license and be insurable under the Agency's insurance. WHY CHOOSE STARCARE? Welcome to StarCare Specialty Health System, where your passion for making a difference thrives! At StarCare, we imagine a community where all people have hope and the opportunity to achieve their full potential for health and wellbeing. Here's why you should choose StarCare: Impactful Purpose: Contribute to meaningful change as the state-designated Local Authority for mental health, intellectual disabilities, and substance use disorders. Be a catalyst for positive empowerment. Comprehensive Care: StarCare offers a diverse array of specialty healthcare services that support and empower people as valued members of the community. Collaborative Environment: StarCare is proud to work with a network of community stakeholders to ensure all people have access to the healthcare they need. Professional Growth: StarCare offers many different opportunities for growth in the fields of mental health, substance use disorders, aging, intellectual & developmental disabilities, veterans, and healthcare administration. Come grow your career with us! Legacy of Service: Since 1967, StarCare has provided hope and health to Lubbock, Hockley, Lynn, Crosby, and Cochran counties. At StarCare Specialty Health System, your work is not a job. It's a fulfilling journey of providing hope and supporting and empowering people as valued members of the community. Ready to get started? We've been waiting for you! EEO Statement: StarCare Specialty Health System provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Created: 2024-10-15