Quality Assurance & Utilization Manager

Job Description

Salt Lake County…A career with a purpose in the community you love!

Salt Lake County invites you to explore our exciting career opportunities. We seek highly enthusiastic individuals to enrich our County with your experience and talent. If you enjoy working in a team environment that is committed to changing the lives of its community, please keep reading.

What it is like to work here:

At Salt Lake County our culture is woven into all aspects of our work and our employees’ lives, from the way we treat each other to the way we support the community.  To promote and foster a fun and healthy work environment, we appreciate employees through great benefits, a healthy work life balance and room to grow and develop.

Surround yourself with:

Peers who are motivated to make a difference in the lives of those we serve. We serve Salt Lake County and envision a safe and beautiful place for all to live, work and have fun. Salt Lake County is about connecting people and championing our community.  Community is more than a place….its our heart and service that bring us together.

We encourage a work life balance:

Working for Salt Lake County is more than just a paycheck.  A career with /Salt Lake County includes several benefits and perks.  We support our employees with 12 Holidays, up to 24 vacation days, 12 sick days and one personal day every year.

Additional Benefits include:

• Retirement options for hybrid pension/401(k) or 401(k) only with a 10% contribution
• Medical coverage including a 100% county paid premium option-Dental and Vision coverage including coverage for adult designees
• Health Savings account with a county contribution up to $1200/year, Flexible Spending Account
• 100% county-paid Long-Term Disability and Short-Term Disability option
• Professional Development including professional membership fees paid
• Tuition Reimbursement
• Plus: Onsite medical clinic and gym; pet insurance auto and home insurance and discounts at County facilities. 

For Benefits information Click HERE 

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JOB SUMMARY

Provides supervision and oversight of the Quality Assurance and Case Management teams. Provides oversight and implementation of auditing processes to ensure adherence to local area contracts and utilization of Best Practices. Manages and directs the appeals process for the Medicaid contract(s).

MINIMUM QUALIFICATIONS

Master's degree from an accredited college or university in Social Work, Psychology, Marriage and Family Therapy, Ed. Psychology, or other closely related field, plus two (2) years of related experience, of which one (1) year must have been in a supervisory capacity. Education may not be substituted for the required supervisory experience.

Licensed in the State of Utah as a Licensed Mental Health Professional (LCSW, CMHC, or LMFT).

Preference may be given to applicants having experience in substance use disorder and/or mental health treatment, with experience using an electronic medical record.

Due to the nature of this position, the successful applicant must pass a required background check through fingerprinting and enrollment in the continuous RAP Back (Record of Arrest and Prosecution Back) program in accordance with current County Human Resources policy requirements.

A valid Driver’s License accepted by the State of Utah is required at the time of hire.  A valid Driver’s License issued by the State of Utah must be obtained within six (6) months of hire to operate a County vehicle.

ESSENTIAL FUNCTIONS

• Leads and directs the quality assurance auditing processes, ensuring compliance with the agency contract(s) and adherence to Clinical Best Practices Standards.
• Supervises staff including hiring, orienting, training, assigning and reviewing work performance, annual work performance appraisals, and discipline.
• Develops documents to assist reviewers in the auditing process.
• Performs and directs the annual audit of the contracted managed care organization (MCO) for compliance with the agency’s contracts, Clinical Best Practice Standards, and Utah Department of Health Medicaid standards.
• Compiles and submits the annual report of summations from the site visits as part of the auditing process.
• Provides follow-up on corrective or improvement actions as a result of the audit.
• Monitors contracted treatment program compliance with the agency’s contracts, Clinical Best Practice Standards, and Utah Department of Professional Licensing (DOPL) Scope of Practice regulations. Evaluates clinical documentation to ensure conformity with local area contracts and best practices standards.
• Provides oversight and supervision of the utilization review process and ensures compliance with the utilization review policy.
• Monitors clinical documentation to ensure that clients receive clinically appropriate services.
• Directs and oversees the Medicaid Appeals process.
• Completes independent reviews of mental health and/or substance use disorder treatment records submitted with appeals to determine the medical necessity of services rendered.
• Collaborates and coordinates with direct service providers on behalf of the Division.
• Acts on behalf of the agency with the Utah Department of Health Division of Medicaid and Health Financing Office of Formal Hearings.
• Assists staff in facilitating close collaboration with the agency’s treatment contractors, the contracted MCO, County agencies, and community partners.
• Provides training and technical assistance to local contracted treatment providers on utilization of the County's electronic health record and documentation methods.
• Provides training specific to person-centered treatment planning, suicide prevention, and/or the American Society of Addiction Medicine (ASAM) placement criteria.

KNOWLEDGE, SKILLS AND ABILITIES (KSA)

Knowledge of: 

• Medicaid rules and regulations regarding the Prepaid Mental Health Plan (PMHP)
• Current State Division of Substance Abuse and Mental Health preferred practice standards
• Principles and techniques of management and supervision
• Mental health and substance use disorders treatment and prevention, theory, and practice
• Individual, family, and community dynamics regarding mental health and substance use disorders
• Utilization management techniques including case rate purchasing of services
• Records retention policies and procedures
• Federal confidentiality regulations
• Alcohol and drug abuse prevention and treatment continuum in Salt Lake County
• Fiscal management and grant writing
• Health care benefit plans, managed care organizations, and marketing to private health organizations
• Theories, practices, and training techniques in learning, research, and program evaluation
• Community organization, public/media relations

Skills and Abilities to:

• Supervise, train, evaluate, and direct the work of assigned staff
• Communicate effectively both verbally and in writing
• Interpret contractual agreements and direct operations within the scope of these agreements
• Use clinical knowledge and judgment to direct and clinically supervise Division staff
• Perform clinical and program monitoring through utilization management and auditing of treatment agencies
• Organize, manage, demonstrate leadership techniques, and provide mentoring
• Develop and provide program and training materials
• Write, communicate, and speak publicly clearly and effectively
• Present effectively to groups
• Manage time efficiently
• Perform effectively in stressful situations
• Act independently

Additional Information

WORKING CONDITIONS AND PHYSICAL REQUIREMENTS

Work may include long hours sitting at a desk and computer. Hours may vary and require up to ten (10) hours a day. The position requires some traveling between County and local area provider(s) offices.