Supervisor, Utilization Management-ALTCS/BH

Summary/Position Objectives:
This position is responsible for providing clinical supervision of up to ten (10) behavioral health clinicians who provide concurrent review and retrospective utilization review of adults and children admitted to Psychiatric inpatient settings in order to assure quality and cost effective care. Utilization management to include consistent work processes for clinical staff, consistent use of clinical tools (LOCUS-CALOCUS) and development of consistent work processes as appropriate. Includes early identification of individuals who have complex medical and/or psychosocial needs. Daily case assessments, clinical support, education and quality management of members care for inpatient psychiatric care. Coordination on clinical cases with providers, representing Schaller Anderson Behavioral Health of Arizona (SABHA) to enhance the relationships with providers with the primary goal of continuous improvement of patient care and management of patient benefits.

Responsibilities:
Essential Functions:
Direct supervision of clinical staff, primarily clinical review of independent cases to ensure appropriate clinical intervention, coordination, discharge and after-care treatment. As a result of clinical review and in coordination with the care manager, make recommendations for patient length of stays for inpatient care or step-down to less intensive levels of care.
Schedule and direct regular staff meetings to enhance teamwork, inform staff of process changes and to get staff feedback and suggestions. These staff meetings should also be used to review difficult clinical cases with supervisor and/or medical director.
Regular monitoring of clinical notes and clinical process to ensure appropriate documentation to meet regulatory requirements. Monitoring of call statistics for all staff to include care managers and care manager technicians. Addressing outcome of call statistics with staff as related to information outcomes.
Monitoring of reports and provide feedback to Manager on a weekly/monthly schedule.
Responsible for assessing all levels of care and placement within the high-risk behavioral health settings.
Review inpatient admissions using Locus/Calocus guidelines to determine the appropriateness of the admission.
Coordination with Medical Director on cases that need review for admissions, continued length of stay, benefit interpretation, outcome decisions or if in need of consultation.
Communication with contractors on a regular basis regarding questions/concerns that need to be addressed timely and appropriately. Escalated issues are reviewed with the Manager.
Communication with hospitals and review staff to discuss issues on patient care, appropriate levels of care and length of stay.
Identify discharge-planning needs upon admission to hospital, skilled nursing facility or high-risk group homes; involve appropriate resources, such as discharge planners and social workers as necessary.
Assist in the development of desktops for clinical staff to refer to regarding various procedures/protocols.
Assist in the facilitation of training for care management staff and providers.
Preparation of utilization reports to present to the manager on a regular basis and on timelines to meet Health Plan guidelines.
Participate in program development and assist in the identification of program needs.
Responsiveness to Management requests regarding utilization questions/reporting/clinical intervention.
Assures compliance with state and federal regulations governing ALTCS case management.
Facilitate the effective coordination of activities with all departments within SCHN to ensure appropriate support for all ALTCS case management activities.
Maintain close working relationship with the PA Department and Concurrent Review staff to ensure behavioral health hospitalizations are cost effective.
On-call availability for after-hours staff with administrative questions.

ABOUT SCHALLER ANDERSON:

Schaller Anderson administers Medicaid and employer self-funded health plans, and manages behavioral health plans. The company’s suite of services includes member services; provider services; claims processing; information services; financial reporting and analysis; medical management; and grievances and appeals services. Schaller Anderson has also been engaged in several consulting projects for states, health plans and providers. Schaller Anderson and its affiliates have 1,400+ employees nationwide and administer health plans with over 1.6 million members. Recently, the Initiative for a Competitive Inner City and Inc. magazine named Schaller Anderson to the Inner City 100, a list that recognizes the fastest-growing companies in America’s core urban areas. Schaller Anderson placed eighth among 5,000 entries in the Inner City 100 competition and was the only health care management company in the top 10.

The VISION of Schaller Anderson, Inc. is to be recognized as the nation’s foremost managed care resource by providing the highest value management and consulting services throughout the health care continuum.


BENEFITS:

Schaller Anderson team members are provided with countless opportunities to make a real difference and the following compensation/benefits:

* Competitive compensation DOE
* Medical, Dental and Vision insurance
* Employee Assistance Program
* Flexible spending accounts
* On-site fitness center (Phoenix headquarters only)
* Life insurance and accidental death and dismemberment insurance
* Short-term and long-term disability
* Paid holidays, paid time off/paid time off reserve
* 401(k) and profit sharing
* Tuition reimbursement
REQUIREMENTS
Knowledge and Skills:
Must be highly clinically skilled in making serious clinical decisions for health plan members and their families.
Excellent communication, negotiation and mediation skills to work with internal and external customers.
Excellent analytical skills.
Excellent computer skills to include Microsoft Office software. Excel or database experience important.
Knowledge of behavioral health managed care.
Performance management knowledge with skills to address supervisory issues with staff as needed.

Education and Work Experience:
A Master’s degree in the behavioral health field with a current Independent State of Arizona license is required. Five (5) years post masters degree preferred. Two (2) years of Supervisory experience required. Minimum of 2 years’ work experience in a managed care environment. Hospital work history strongly preferred to encompass the scope of need for clinical review.