LOCATION
301 S Crapo Street, Mount Pleasant, MI 48858
SCHEDULE
This is a full time, hybrid position, 40 hours per week. Schedule is typically Monday through Friday 8am - 5pm.
COMPENSATION & BENEFITS
Salary: $50,357 - $68,515 depending on experience
JOB SUMMARY
General Description: The provider network monitor is responsible for conducting provider reviews and verification audits for the six county board area and monitoring provider compliance with agency, state, federal and accreditation standards. Provides consultation and technical assistance to network providers regarding contractual terms including service documentation and claims submission requirements.
Responsibilities and Duties: Monitors service utilization and conducts on-site and/or desk audits of providers and individuals with self-determination/choice voucher arrangements as assigned to assure the presence of acceptable service documentation to support reported service events. Reviews provider claims submissions, case record documentation including person-centered plans and electronic data system reports. Monitors providers operational and policy/procedure systems in areas such as environment of care, safety, recipient rights and quality improvement. Requests corrective action plans and provides follow-up to ensure required action is completed. Prepares reports of compliance results for quality assessment and performance improvement purposes. Maintains a log of site review information and corrective action plans including database data entry for purposes of evaluating aggregate information. Orients providers on service documentation and billing requirements and other contractual terms. Assists providers in resolving problems with claims, fee schedules and authorizations. Provides training and technical consultation to case managers and others regarding self determination/choice voucher arrangement processes and procedures. Ensures that all required trainings, budgets, background checks and agreements are in place for self-determination/choice voucher arrangements. Participates in the collection and preparation of operating reports and documentation, including statistical records of performance data as required. Analyzes program operating practices, such as service code changes, record keeping systems, forms development, budgetary requirements, and performance standards to create new systems or revise established procedures. Studies program management methods and submit recommendations to improve workflow, simplify reporting procedures, or implement cost reductions. Participates on agency committees. Reviews and answers correspondence. Compiles stores and maintains management data using the computer. Coordinates and provides training on assigned topics for staff, providers and community members. Enhances and maintains the CenTrain direct care worker curriculum. Coordinates Consumer Action Committee events as assigned. Acts as staff liaison to the Consumer Action Committee including meeting preparation, recruitment and coaching committee members, committee communication and project management. Routinely informs consumers of opportunities for involvement on various boards, councils and work groups managed and used by the Agency. Provides markets and coordinates Mental Health First Aid Trainings including scheduling, facilitating and follow up. Performs other duties as assigned.
The above statements are intended to describe the general nature and level of work being performed by people assigned this title. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified. They are not intended to limit or in any way modify the right of supervisors to assign, direct, and control the work of employees under their supervision. The above statements will also incorporate knowledge about and actively support: 1) culturally competent recovery based practices, 2) person-centered planning, and 3) a trauma informed culture of safety to aid consumers in the recovery process as applicable to the work performed.
EMPLOYMENT STANDARDS
General Education: College: Bachelor's degree Major: Social Work, psychology or similar mental health specialty.
Job-Related Experience: Sufficient experience to perform the position at a satisfactory level required. Experience in fiscal data analysis and healthcare preferred.
Licenses, etc.: Michigan LBSW or individual with a human services degree hired and performing in the role of QMHP/QIDP prior to January 1, 2008 is preferred. Valid driver's license while operating vehicle while on agency business.
CONDITIONS OF EMPLOYMENT
Knowledge: Knowledge of fiscal and administrative functions in a mental health setting. Knowledge of developmental disabilities and mental illness, community mental health policies and procedures and data systems. Knowledge of the Medicaid program covering behavioral health and developmental disability supports and services. Knowledge of community resources and management techniques. Knowledge of principles of self-determination and person-centered planning.
Skills: Use of telephone, calculator, and copy machine. Computer skills including, electronic medical records, spreadsheets and database applications.
Abilities: Effective oral and written communication, organization and data maintenance, problem solving, and mediation abilities. Ability to maintain favorable public relations. Ability to exercise considerable independent and mature judgement in carrying out the duties and responsibilities of the position. Ability to work with various county agencies and follow administrative policies and directives. Ability to be flexible and provide small group leadership. Ability to serve in an administrative function. Ability to plan and organize work to maintain and develop services to individuals with developmental disabilities and mental illness.
Physical Demands: Work is sedentary and involves typical office behaviors such as reaching, handling, and fingering. Some travel is necessary. Near acuity necessary for typed letters and checking/copying figures.
Work Environment: Work is performed in a typical office setting. Some travel is required to attend community meetings.