Coord QI Utilization Mgmt

Position Summary

The Coordinator is responsible for coordinating insurance initial authorization, concurrent reviews,

monitoring quality data, and collecting and monitoring adherence to BH core measures.

Primary Position Responsibilities

1. Responsible for coordinating and managing insurance authorizations and concurrent reviews for

the HBH service line

2. Responsible for managing ALL Quality and PI data for the HBH service line

3. Human Resource and Fiscal Management

4. Coordinates performance improvement activity throughout the organization and creates annual

reports for all performance improvement activity

5. Provides appropriate reports for performance improvement activities which include the PI tools of

histograms, pareto charts, run charts or control charts with each project, as needed.

6. Works with the Regulatory; Accreditation Specialist to ensure compliance for successful survey

with all DMHAS, DOH, TJC, and CMS as needed. Ensure inspection, monitoring, implementation plan

and reports are completed by due date

7. Uses available clinical databases to identify opportunities for improved patient outcomes,

organizational efficiencies and organizational cost reduction.

8. Partakes in CRC meetings and FMEAs developing and providing oversight to action plans.

Qualifications

Minimum Education : Required :

Bachelor’s degree in Psychology or Sociology or relevant field

Preferred :

Graduate degree in Psychology or sociology or relevant field

Minimum Years of Experience (Amount, Type and Variation) :

Required :

Greater than 2 years in Behavioral Health leadership

2 plus years’ experience with QI / PI collection, compiling and processing data

Knowledge, Skills and / or Abilities :

Required :

Knowledge of insurance authorizations, concurrent reviews for insurance,

collecting and compiling QI / PI data

PI262178568