Regional Utilization Review Coordinator (Hybrid Remote)

Overview

This position is a responsible administrative and clinical role focused on organizing and tracking utilization review (UR) data for Alabama’s Region II mental health centers. Region II includes the service areas of West Alabama Mental Health Center, Indian Rivers Behavioral Health, Cahaba Center for Mental Health, Central Alabama Wellness, JBS Mental Health Authority, and AltaPointe Health - North (Clay, Coosa, Talladega, and Randolph counties). The employee reports directly to the AltaPointe North Clinical Director for the provision of UR services and collaborates closely with Region II community mental health centers (CMHCs) and the Alabama Department of Mental Health (ADMH) regarding UR activities. This role requires advanced clinical expertise and a comprehensive understanding of utilization review principles as they apply to community mental health residential programs.

 

Hybrid (remote/in-office schedule).  In-office or on-location presence is required when needed, based on operational demands. The remaining workdays may be completed remotely, subject to organizational needs and individual performance, and with supervisors approval.  Travel to AltaPointe locations, CMHCs within Region II, community programs, ADMH administrative offices, and state hospitals, is required when deemed appropriate.   

Responsibilities

PRIMARY JOB FUNCTIONS:

 

Coordinates with ADMH on issues related to housing/residential/crisis slots in Region II area.

• Responsible for collecting, tracking, and reporting UR data provided by Region II CMHCs via the UR tracking protocol spreadsheets/documents specified by ADMH in a timely and accurate manner (i.e. census, readmissions, discharges, etc).
• Assists ADMH in maintaining a complete and accurate database for all certified housing/residential programs, as well as Crisis Residential Units (CRUs) and Designated Mental Health Facility (DMHF) Hospitals, in the Mental Illness Community Residential Services (MICRS) reporting system.
• Monitor lengths of stay in residential programs in Region II.
• Conduct Discharge Planning Conference call at least once per month with all Region II providers to staff service recipients currently under Civil Commitment or at risk of Civil Commitment who are at Bryce Hospital, DMHF CRU, and/or DMHF Hospital.as well as staff service recipients in housing/residential who need outplacement and barriers complicate such discharge.
• Attends/participates in the monthly staffing of Bryce service recipients held by ADMH and be prepared to discuss housing/residential vacancies throughout Region II.
• Attends training related to UR function as provided and/or coordinated by ADMH.
• Participates in trainings and meetings to assist ADMH and the Regional Board of Supervisors (BOS).
• Actively participates in the utilization review and management of continuum and Region II resources.

Acts as residential placement liaison for service recipients in Region II and their assigned community mental health centers:

• Develops a thorough understanding of all community mental health center-operated or contracted housing and residential services in the area, with a focus on admission criteria.
• Maintains a working knowledge of all CMHC residential and housing services in Region II, state hospitals, DMHFs, and inpatient community resources serving the Region.
• Makes regular contact with appropriate staff involved in service recipients’ care coordination, case review, and discharge planning at various facilities and programs.
• Coordinates discharges into residential services across catchment areas as needed or requested by community mental health centers, state hospitals, or ADMH. This coordination is intended to complement, not replace, the essential responsibilities of the CMHC.
• Assists ADMH and community mental health centers in locating options for service recipients who have special needs that cannot be met in their home area.
• Help facilitate movement to out-of-state facilities, CRUs, and/or housing/residential by assisting with difficult placements.

 

Supervision and consultation.

• Seeks supervision and consultation as needed.
• Adheres to professional code of ethics.
• Accepts and employs suggestions for improvement.

 

Courteous and respectful attitude

• Treats service recipients with care, dignity and compassion.
• Respects service recipients’ privacy and confidentiality.
• Is pleasant and cooperative with others, including service recipients and families.
• Personal values do not inhibit ability to relate and care for others.
• Is sensitive to the service recipients’ needs, expectations and individual differences.

Administrative and other related