ResponsibilitiesThe incumbent conducts document-based quality reviews and quality management processes for contracted onsite assessments, determining necessity for contract specific medical and/or psychiatric services.The Ideal Candidate will Possess the Following Additional Education and Experience
1.Conducts quality management processes on assessments completed by contracted field assessors and/or other clinical reviewers to ensure assessments adhere to state-directed criteria for determining medical need.
2.Schedules and conducts document-based quality reviews that adheres to state-directed clinical criteria for determining medical need.
3.Responsible for engagement and performance feedback for assessors (ICs), including onboarding assistance, making/following-up on referrals, tracking responsiveness, and informing both R&C and supervisor in writing when performance and/or responsiveness issues arise with any IC.
4.Attends and participates in scheduled contract, committee, and all-staff meetings.
5.Performs other job duties as assigned.
Knowledge, Skills & Abilities
Ability to work in a fast-paced environment while maintaining a high level of quality.
Ability to perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies
Knowledge of diverse cultures and gender specific issues and the ability to incorporate needs of gender and culturally diverse groups into utilization review decisions
Working knowledge of DSM criteria, psychotropic medications, and medical diagnoses
Ability to multitask effectively while performing job duties, including ability to prioritize tasks and ensuring all voice mail and email messages are returned within six business hours of receipt
Ability to work independently with minimal day-to-day supervision
Excellent written and verbal communication skills
Excellent interpersonal skills
Ability to interact professionally and collegially with referral sources (hospital & nursing home staff, physicians, social service workers, etc.), state contract officers, and coworkers
Ability to define problems, collect data, establish facts, and draw valid conclusions
Intermediate skill with word processing and spreadsheet software (Microsoft Word and Excel preferred)
The job requires a Master's degree in Health, Human Services, Sociology, Psychology, or related field.
The job requires three (3) or four (4) years of experience (contract-specific) working directly with individuals with mental health diagnoses. Experience working with individuals with intellectual disabilities might be helpful.
EEO StatementEEO Statement: Active military service members, their spouses, and veteran candidates often embody the core competencies MAXIMUS deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We're proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. MAXIMUS is an Affirmative Action/Equal Opportunity Employer. MAXIMUS provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.