Utilization Management Specialist

Children's Network of Hillsborough•Egypt Lake-Leto, FL

1d•Onsite

About The Position

The Children’s Network of Hillsborough is committed to working with the community to protect children and preserve families. 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.

Requirements

Bachelor’s degree (B.A.) from a four-year accredited college or university
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
Exceptional leadership and communication skills, fostering collaboration across all organizational levels.
Possess a strong aptitude for analytical thinking and data-driven decision-making, they excel at solving complex problems and implementing effective solutions.
Proficient in project management, they adeptly handle multifaceted initiatives, ensuring deadlines are met and budgets are maintained.
Highly adaptable to fast-paced and dynamic environments, they prioritize tasks efficiently while leveraging operational software and tools to enhance productivity.
Strategic planning expertise and a commitment to fostering teamwork enable them to drive organizational success.
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
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.
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.
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.

Nice To Haves

Florida Child Welfare Certification (Case Management or Investigations) is preferred.
Knowledge of local community services is desired

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.
Other duties may be assigned as special projects may be requested