Utilization Manager (Management Analyst III)
Provides project management, cross service coordination, and the administrative oversight necessary to plan, design, implement, and sustain clinically sound Utilization Review (UR) and Utilization Management (UM) processes that support individual choice and cost effective outcomes. Assist in helping to inform and apply UM principles and processes throughout the agency to ensure that clinical services are positively impacted through this knowledge transfer. Provides research and analytical support by utilizing information technology tools, databases, the CSB's electronic health record, and budgetary information. Prepares narrative and statistical reports regarding utilization review, management, and costs. By establishing and maintaining relationships with support coordinators (SC), case managers, private provider organizations, and other stakeholders, will evaluate the efficacy and efficiency of the agency's UR/UM systems. Uses established guidelines to review individual support needs, functional assessments, and service requests to support the decision to initiate or continue services.
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Any combination of education, experience, and training equivalent to graduation from an accredited four-year college or university with a bachelor's degree in field related to the assigned functional area; plus four years of professional work experience with in the functional area such as human resources, budgeting and financial management, contract administration and business management, business administration, public administration, mathematics, statistics or related field.
NECESSARY SPECIAL REQUIREMENTS:
The appointee to this position will be required to complete a criminal background check, a Child Protective Services Registry, a driving record check, and a check with the Office of the Inspector General (OIG) to the satisfaction of the employer.
Master's degree in social work, human services, psychology, or similar field, plus at least 10 years' experience working in similar increasing management position within the behavioral health care environment. Extensive knowledge of utilization review processes, standards, and tool, public/private insurance benefits, behavioral health compliance and quality assurance standards and practices, and electronic medical record data reporting. Must also possess experience collaborating with community partners, boards, and diverse clinical staff. Ability to communicate clearly and concisely, both orally and in writing.
Ability to travel to conduct site reviews and attend meetings off-site. Ability to use automated technology including a computer 6-8 hours a day. All duties performed with or without reasonable accommodations.
It is the policy of Fairfax County Government to prohibit discrimination on the basis of race, sex, color, national origin, religion, age, veteran status, political affiliation, genetics, or disability in the recruitment, selection, and hiring of its workforce.
Reasonable accommodations are available to persons with disabilities during application and/or interview processes per the Americans with Disabilities Act. Contact 703-324-4900 for assistance. TTY 703-222-7314. EEO/AA/TTY.