Utilization Management Specialist

General Purpose of Job

To act as a liaison between the Case Management Organizations (CMOs), the Department of Children & Families (DCF) and specialty and/or community providers to facilitate identification of service needs and provision of appropriate and timely services to children and families with the goal of moving cases toward permanency.  The UM specialist takes a primary role in ensuring the effective management of allocated resources. 

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Duties and Responsibilities

• Prepare initial authorization of paid, purchased, and contracted and Medicaid funded services funded by the Lead Agency ensuring that authorizations are generated quickly to facilitate initiation of services to children and families.
• Works with the Point of Contact (POC) to serve as the central point of contact for case managers in referring children for Comprehensive Behavioral Assessments (CBAs), other behavioral assessments as needed and mental health services. 
• Process and track the progress of Comprehensive Behavioral Health Assessment (CBHA) referrals.  Receive completed assessments and process service authorizations once approved. 
• Cultivates effective communications and working relationships with network of service providers.
• Maintain accurate client records of service requests, authorizations, and payments processed. 
• Evaluate and process flex fund and community development requests.
• Track process of referrals for Suitability Assessments (QE), adherence to time frames, including level of care; admit dates, changes in level of care, name of therapeutic providers.
• Processes invoices from providers for payments. 
• Work together as a team with co-workers to streamline processes and maintain unit efficiency and quality of work.
• Monitors email on daily basis.  Circulate pertinent information to unit staff members.
• Maintain regular in-office attendance to perform essential job functions, collaborate effectively with team members, participate in meetings, and provide timely support to agency operations and service delivery.
• Perform other duties as assigned to support departmental and agency goals, as needed and appropriate to the position.

Working Hours

Children’s Network of Hillsborough’s standard business hours are 8:00 a.m. to 5:00 p.m., Monday through Friday. This position is an in-office based position that averages 40 hours per week. Work hours may vary outside of these standard hours, including evenings and weekends, as needed to meet operational demands. All hours worked will be compensated in accordance with the Fair Labor Standards Act (FLSA) and agency policies, including applicable overtime and other compensation requirements.

Travel

Travel within and outside of Hillsborough County is required. 

Training

All employees are required to complete fifteen (15) hours of training annually, which may be completed online or in a classroom setting. Employees who hold a credential or license relevant to their position must ensure that all training and continuing education requirements are met to maintain their credential or licensure

Supervisory Responsibilities

This position does not have supervisory responsibilities

Education and Experience

Bachelor’s degree (B.A.) from a four-year accredited college or university; Florida Child Welfare Certification (Case Management or Investigations) is preferred.

Other Qualifications

• Minimum of one (1) year of experience in Child Welfare, social services, behavioral health care, or related field
• Excellent organizational and problem-solving skills
• Self-motivated with the ability to manage various work assignments simultaneously
• Ability to establish and maintain positive working relationships with others
• Knowledge of local community services is desired

Skills and Abilities

Must be able to operate standard modern office machinery, including fax, telephone, calculator, computer, scanner, printer, copier and mail machine.  Minimum typing speed of 45 wpm; excellent word processing skills.  Must be competent with Microsoft Office Suite programs, including Word, Excel, Power Point, Access, Publisher and Outlook.  Must be competent with basic e-mail protocol and procedures including sending, receiving, replying, attachments, and meeting scheduling; excellent written and oral communication skills; effective listening skills; ability to work as a team member, and the ability to work in a multi-cultural environment.  Must abide by the highest standards of confidentiality.

Pre-employment Requirements

• Valid driver’s license required, with proof of insurance
• Driver’s license check is a requirement
• Criminal background screening (fingerprinting) (Local Law Enforcement and FBI/FDLE)
• Drug Screening is a requirement
• Children’s Network participates in E-Verify

Other Requirements

Language Skills

Ability to read, analyze, and interpret common scientific and technical journals, financial reports, legal documents, and/or governmental regulations.  Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.  Ability to write speeches and articles for publication that conform to prescribed style and format.  Ability to effectively present information and respond to questions from groups of managers, clients, public groups, and/or boards of directors.  Ability to speak effectively before groups of customers or employees.

Mathematical Skills

Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals.  Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Reasoning Ability

Ability to define problems, collect data, establish facts, and draw valid conclusions.  Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.  Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.  Ability to be proactive, as well as handle problems involving several concrete variables in standardized situations.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This job requires the ability to sit for extended periods; walk; stand; use hands to finger, handle or feel; reach with hands and arms; stoop, kneel or crouch; talk and hear.  This job requires visual acuity sufficient to read and to operate standard modern office machines.  The employee must occasionally lift and/or move up to 25 pounds.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This is administrative work in an indoor office environment with a moderate noise level (business machines, printers, computers, telephones).