Utilization Manager, Home and Community Based Services (Statewide)

Company Lutheran Services of Georgia
Location Atlanta, GA
Update 4 Day ago
300
The Utilization Manager (UM), Home and Community Based Services (Statewide) provides on-site expertise to all programs statewide within Home and Community Based Services and monitors and evaluates programs’ regulatory compliance, and implements state and agency policies/procedures. The UM Manager compiles, coordinates, provides technical assistance and training, and monitors all policies/procedures for compliance and quality improvement. The Utilization Manager (UM) serves as the Client Advocate/Ombudsman.

Essential Responsibilities:
  • Reviews all State of Georgia (Department of Human Services, Division of Family and Children Services; Office of Residential Child Care; Office of Provider Management; Department of Juvenile Justice: Department of Public Health; Office of Family Prevention and Support, Department of Behavioral Health and Developmental Disabilities, Medicaid Waiver Manuals) and Council on Accreditation (COA) standards to ensure that HCBS is in compliance with all relevant requirements.
  • Reviews LSG polices to ensure they are in compliance with all relevant HCBS requirements
  • Makes recommendations to Clinical Director and HCBS Director on policy revisions based on requirements.
  • Reviews Extended Reach and ensures the database is capturing required information
  • Produces preliminary reports based on Operations initial trend analysis based on data captured through the data base
  • Completes routine qualitative audits, documents in Extended Reach and provides recommendations
  • Works with Operations to ensure that to develop and revise policies to reflect all regulatory guidelines.
  • Completes refutations for citations as a result of audits conducted by Medicaid, Office of Provider Management (OPM), and Office of Residential Child Care (RCC)
  • Reviews all Investigative Reports
  • Develops training programs to prepare managers and staff to best provide quality programming while remaining compliant with all policies and procedures.
  • Completes at least quarterly qualitative reviews of client and caregiver records and prepares sites for annual regulatory site visits.
  • May travel to LSG’s satellite offices quarterly to provide on-site technical assistance, training, and audit preparation.
  • Participates in review of other program areas on an as-needed basis.
  • Participates on the Critical Incident Review Team and Behavior Management Team.
  • Documents errors and gaps in all files and records.
  • In collaboration with other HCBS Program Managers, develops and implements on-site training efforts to assist staff in correcting deficiencies.
  • Generates reports for Program Managers and Directors that indicate individual staff and program-wide problems, and that classifies the errors by type, cause and recommended corrective strategies.
  • Serves as the client advocate/ombudsman and manages client grievances.
  • Conforms with and abides by all regulations, policies, work procedures and instructions.
  • Complies with various federal, state, and/or local laws that apply to and regulate the job responsibilities.
  • Participates in training, fundraising events and other LSG activities and initiatives such as performance and quality improvement (PQI).
  • Strives toward excellence in the areas of innovation, performance, and extraordinary acts.

Non-Essential Responsibilities:
  • Performs other duties as assigned to meet program needs.

Supervisory Responsibilities: None

Financial Responsibilities:

Manages funds and other LSG assets, i.e. supplies and equipment in a manner that is considered productive, in the best interest of LSG, and conforms with approved budgets.

Qualifications

Minimum Qualifications:
  • Bachelor’s degree in a human service, nursing or related field and at least 3 years of experience in utilization management, contract compliance, reviewing external requirements, chart audits.
  • Working knowledge of State of Georgia rules and regulations that apply to all programs within Home and Community Based Services.
  • Experience developing and delivering targeted training.
  • Excellent oral and written communication skills.
  • Ability to interpret and write policies and procedures.
  • Ability to review files and records for compliance with respective regulations.
  • Ability to analyze and review data and to write reports
  • Conviction about the capacity of people to grow and change
  • Ability to work in a spirit of partnership and collaboration with other team members
  • Ability to function independently and have flexibility, personal integrity and ability to work effectively with children, co-workers, and stakeholders.
  • Excellent oral and written communication skills.
  • Experience monitoring program compliance to regulatory requirements
  • Effective time management skills, ability to maintain own schedule to complete tasks assigned within a timely fashion.
  • Must be computer and internet literate with competencies in Microsoft Office Suite (Excel, Word, Outlook) and database/electronic case management system
  • Must have the ability to communicate with all persons in a culturally competent manner.
  • Must be sensitive to the service population’s cultural and socioeconomic characteristics.
  • Must hold a valid Georgia Driver’s license, possess a reliable personal vehicle, and have personal auto insurance, and a good driving record.
  • Or an equivalent combination of education, experience, competencies, skills and knowledge that ensures the successful completion of the essential job responsibilities.

Desired Qualifications:
  • Master’s Degree in a Human Service or a related field from an accredited school.
  • Knowledge of extended Reach, SHINES, GA SCORE, PSSFWeb
  • Experience with Medicaid, Office of Residential Child Care, Office of Provider Management, Council on Accreditation

Physical Demands:

Regularly required to talk and hear. Required to stand, walk, sit, use hand to finger, handle or feel objects, tools or controls: and reach with hands and arms. Required to operate personal vehicle.

Employee frequently lifts and or moves 35+ pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Working Conditions:

While performing the responsibilities of this job, the employee travels by automobile and is exposed to changing weather conditions. The Utilization Manager may attend training and conferences out of town requiring overnight travel. This position is a member of the mobile workforce. This position travels locally and statewide approximately 20% of the time.