Managed Care Operations Administrator

Classification Title

Managed Care Operations Administrator

Salary

$85,183.29 - $110,177.47

Department

Community Mental Health

Opening Date

02/18/2025

Closing Date

02/25/2025 12:00 a.m.

FLSA STATUS: Exempt

EMPLOYMENT RELATIONSHIP: Just cause subject to probationary period

General Summary

Under direction, is responsible for quality-based initiatives and general managed care-related administrative functions within the Macomb County Community Mental Health (MCCMH) Managed Care Operations (MCO) division. Acts as a liaison for the division in implementing policies and procedures related to the fulfillment of contract obligations, oversees data analytics, assists with the macro-oversight of the department, and interfaces with other division chiefs, directors, and the provider network.

Essential Functions And Responsibilities

Directs call center protocols for individuals seeking non-emergency behavioral health, development disability, or substance use disorder treatment.

Educates staff on industry requirements such as state mandates, Medicaid Provider Manual changes, initiatives, Mental Health Code changes, Centers for Medicare & Medicaid Services (CMS) updates and Prepaid Inpatient Health Plan (PIHP)/Community Mental Health Services Program (CMHSP) contract requirements.

Participates in audits and accreditations including Commission on Accreditation of Rehabilitation Facilities (CARF), Health Services Advisory Group (HSAG), Michigan Department of Health & Human Services (MDHHS), and National Committee for Quality Assurance (NCQA).

Reports on the service needs of the MCCMH network, identifying the types of services and providers needed to improve access to the system of care.

Identifies, monitors, and measures limitations in the MCCMH system of care.

Responsible for the maintenance of the Utilization Management program description, department policy, and procedures for the network.

Assists in the interviewing, hiring, and onboarding of staff.

Provides supervision to assigned staff, including orientation, training, weekly or bi-weekly supervision meetings, performance reviews, case consultation, and record review.

Assists with building and maintaining the MCO handbook and staff training guides.

Represents MCO at community stakeholder events, human service organizations, public health and health care organizations, and funding organizations.

Assists in the development of special initiatives.

Represents MCCMH at conferences, state meetings, and work groups.

Must be available to work flexible hours and on-call rotation.

Operates an automobile to perform assigned job functions.

Performs related duties as assigned.

Qualifications

Required Education and Experience

• Master’s degree from an accredited college or university in Psychology, Social Work, Counseling, or Doctorate in Psychology or a directly related mental health field
• Three (3) years of clinical experience with persons with serious mental illness, intellectual or developmental disability, serious emotional disturbance, or substance use disorders
• Two (2) years of experience as a supervisor of professional staff
  
  

Preferred Education And Experience

• Three (3) years or more of experience participating in the preparation of audits such as Commission on Accreditation of Rehabilitation Facilities (CARF) or Health Services Advisory Group (HSAG)
  
  

Required Licenses Or Certifications

• Licensed Master Social Worker (LMSW), Limited License Master Social Worker (LLMSW), Licensed Professional Counselor (LPC), Limited License Professional Counselor (LLPC), Temporary Limited Licensed Psychologist (TLLP), or Licensed Psychologist (LP)
• Possession of a valid Michigan driver’s license and operable, insured automobile for authorized travel
  
  

Preferred Licenses Or Certifications

• Certified Advanced Alcohol and Drug Counselor (CAADC) certification through the Michigan Certification Board for Addiction Professionals (MCBAP) or an approved development plan
  
  

Knowledge Of

COMPETENCIES FOR SUCCESSFUL PERFORMANCE OF JOB DUTIES

• Applicable computer applications, including electronic medical record (EMR) systems
• Michigan Mental Health Code and the Medicaid Provider Manual
• Severe mental illness, serious emotional disturbance, substance use disorders, and intellectual/developmental disabilities
  
  

Skill In

• Using good professional judgment for the welfare and safety of persons served
• Excellent written and oral communication skills
• Providing timely customer service
• Assigning, prioritizing, monitoring, and reviewing work assignments
  
  

Ability To

• Collaborative: Approaches all situations with a teamwork and solution focused mindset demonstrated through active participation in meetings, volunteering to assist teammates and other departments as appropriate. Examples include participation in internal and external committees, subcommittees, process improvement groups or other multi-organizational initiatives
• Accountable: Takes ownership and empowers others to do the same as evidenced by identifying solutions and acting on job responsibilities and organizational objectives, daily
• Respectful: Treats people with dignity while honoring individual differences demonstrated through use of positive and encouraging statements and/or interactions to, about and/or with colleagues and persons served; evidenced by supervisor observation, feedback from other department staff and leadership
• Supervise and direct the work of staff
• Engage effectively with diverse communities; interact with people in an inclusive manner that respects cultural and socio-economic differences
• Work in an environment which embraces the county’s Dignity Campaign
• Effectively speak, write, and understand the English language
• Effectively speak, write, and understand a language other than English is preferred
• Understand and carry out oral and/or written instructions
• Accurately organize and maintain paper documents and electronic files
• Maintain the confidentiality of information
• Work independently
  
  

General Requirements And Disclaimers

Complies with P.A. 390, as amended, known as the State’s Emergency Management Act and the County’s Emergency Management resolution as well as all related plans, policies and procedures covered by those statutes.

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by employees in this job. Employees may be requested to perform job-related tasks other than those specifically presented in this description.

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment amongst other possible accommodations.

GRANT OR EXTERNALLY FUNDED POSITION –This position will continue only if sufficient grant or external funds are provided.