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Utilization Manager

Department: 8088 - Utilization Management
Location: San Antonio, TX
Work Schedule: Monday-Friday 8:30AM-5:30PM

PURPOSE 

The Utilization Manager will conduct review for authorization of service packages/services, review using clinical information, monitor service delivery and outcomes, provide provider training on the UM process.

TASKS 

  1. Provide diagnostic assessments, treatment plans and other clinical assessments to adult, jail diversion, YES and child consumers
  2. Link and refer consumers presenting to clinic to appropriate services (internal and/or external) as indicated
  3. Ensure clinical documentation is submitted in accordance with Center standards, and meets all designated requirements
  4. Comply with and participate in Quality Assurance and Quality Improvement processes
  5. Conduct prospective, concurrent, and retrospective review for authorization of service packages/services for consumers, providing consultation when needed.
  6. Review recommendations for inpatient admissions funded through all payment resources per Texas Legislative Requirements
  7. Identify General Revenue resources, and recommendations for Involuntary Outpatient Commitments and extended inpatients stays to State Mental Health Facilities
  8. Conduct review using clinical information submitted by providers
  9. Direct contact with providers, and review of medical records to monitor service delivery, outcomes, over/under utilization
  10. Detect outliers and unusual patterns of utilization, and recommend interventions.
  11. Other duties as assigned

MINIMUM REQUIREMENTS 

  1. Current license in the State of Texas as a Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT,) and/or a Counseling/Clinical Psychologist (CCP)          
  2. Master's degree in a behavioral science
  3. Five (5) years’ experience in direct care of persons with a serious mental illness
  4. Five (5) years’ experience participating as a member of a treatment team that develops/monitors treatment plans for persons with chronic and serious mental illness
  5. Must be fully qualified to perform all Local Mental Health Authority (LMHA) UM functions 
  6. Must maintain required credentials and mandatory training requirements to ensure compliance with all State regulations and CHCS policies
  7. Must maintain a valid driver’s license and automobile insurance coverage, be able to travel as needed, and be able to meet on a consistent basis the driving record requirements of the Company’s auto insurance carrier if you drive your vehicle during company business 
  8. Must be able to meet the physical requirements to complete SAMA and CPR training including lifting up to 12 lbs. and supporting up to 55 lbs.; bending, stooping and getting on and off the floor without assistance.

PREFERRED 

       1. Bilingual (Spanish / Emg;ish)

Physical Requirements/Demands = 2

1 = Primarily Direct Patient Care
2 = Primarily Office Work
3 = Primarily Physical Work

Compensation Package 

Recruiting and retaining talented individuals is important to us. At the Center for Health Care Services, we are committed to providing our employees with a total compensation package that includes competitive pay, affordable health and wellness benefits, generous paid time off, flexible work schedules, professional development opportunities and generous retirement savings options.

We have wide range of career opportunities and hope you will join us in our mission!

Apply online today at: www.chcsbc.org