Job Information
NorthCare Network QI-UM Specialist in Marquette, Michigan
QUALIFICATIONS: Bachelor's degree in social work (Master's Degree Preferred), Psychology, Nursing, Public Administration, or related field. A valid State of Michigan license is required. Experience working with/providing services to individuals with mental health disorders required. Three years' experience in the areas of service development and program administration related to behavioral health clinical services preferred. Clinical experience and/or a working knowledge of the principles and practices of intervention, prevention, and support for diverse service populations are at a skill level adequate to assure responsibilities can be carried out.
STATUS/HOURS: Competitive Wage, plus full-time benefits. Regular full-time/80 hours biweekly
SALARY RANGE: $38,693.99 to $68,884.58. Starting salary will be determined based on education, experience, and certification(s).
LOCATION: Marquette, Michigan
NorthCare Network is a Specialty Prepaid Inpatient Health Plan (PIHP) located in Marquette, Michigan and is responsible for the management and service array available to residents of Michigan's Upper Peninsula with behavioral health needs covered by Michigan Medicaid and specialty grants for substance use disorder services.
RESPONSIBILITIES INCLUDE: Under the Supervision of the NorthCare Quality Improvement/Utilization Management Director, this position will assist with the review of data enabling the agency to track and manage clinical efficiency and cost effectiveness. This position will monitor services provided to Medicaid beneficiaries across the Provider Network. Will assist in informing the UM program and recommend appropriate revisions and modifications. Will assist in reviewing data and creating quality initiatives driven by the data. Will assist with documentation reviews. Will review and monitor progress with corrective actions plans issued by external auditors. Will assist with continuing stay reviews as necessary.