Saginaw County Community Mental Health Authority · 10 hours ago
Auditor
Saginaw, MI
Full-time
Onsite
Mid, Senior Level
$63K/yr - $77K/yr
5+ years expSaginaw County Community Mental Health Authority is seeking a Residential Coordinator & Provider Network Auditor. This role involves providing education and support regarding residential options and conducting program audits to ensure compliance and quality performance, safeguarding against fraudulent claims. The position requires collaboration with case holders and residential providers to secure appropriate housing options and ensure adherence to regulatory standards.
Mental Health Care
Responsibilities
Assist case holders with locating appropriate supports to keep individuals in their current residential living arrangements
Understands the various residential arrangements and can articulate those to case holders
Provides support to case holders with residential placements as needed based upon individual specific assessed needs (AFC, CFC, CCI, CL Supports)
Understands Self Determination and can assist staff in how to refer an individual to this benefit model
Understands the Michigan (MI) Choice Waiver and how this benefit may assist some individuals to be as independent as possible
Reviews clinical charts and relevant documentation to help determine the best placement for individuals
Assist case holders and crisis team members as needed with timely discharge planning of individual(s) requiring residential placement from local/state inpatient, long term care settings, or rehabilitation settings
Conduct on-going monitoring of residential network placement capacity for as-needed recruitment of local child & adult foster care facilities and out-of-county residential services network placement options
Assist case holders and individuals in identifying and overcoming residential barriers in promoting self-sufficiency in the least restrictive setting possible
Understands the requirements of Home and Community Based Services (HCBS) rules and assists with education of staff in understanding the rules
Reviews potential sites for HCBS compliance and coordinates with Mid-State Health Network
Attends all quarterly HCBS Workgroup meetings with Mid-State Health Network and Michigan Department of Health and Human Services (MDHHS)
Tracks all in-county and out-of-county residential placement referrals and provides updates as requested
Review and update all HCBS policies and procedures on an annual basis
Review and provide feedback on the inclusion of the 8 elements for restrictions in the IPOS
Submits all relevant documentation to Mid-State Health Network when requesting placement in a Heightened Scrutiny Setting
Chairs Residential Placement Committee and Residential Watch Committee and any sub-committees
Attend all Clinical Risk Committee meetings
Is a Member of Quality-of-Life Committee
Collaborates with the Contracts Department to ensure accurate updates to the residential vacancy list
Provides on-going training/education to staff about the residential placement process
Completes Contract Action Forms and submits to the designated supervisor and director for approval
Help coordinate and attend all Interdisciplinary Team meetings as a representative of the Residential Placement Committee
Establishes audit samples, basis, schedules and plans with audit team members
May be assigned specific program types for audit tasks based on experience or SCCMHA needs
Contributes to audit program development; recommends modifications based on testing or use
Conducts annual, routine or ad-hoc SCCMHA audits or provider reviews to meet organizational goals
Identifies areas of deficiency based on audit results, and recommends corrective areas for provider network members, including causation analysis and implementation of preventative actions
Presents audit findings to providers, including explanation and justification for negative findings and/or audit score levels
Reviews provider corrective action plans and outcomes for compliance to audit standards and recommends SCCMHA and provide proactive steps for future compliance
Conducts audits or performance reviews based on consistent, objective standards
Verifies that service events occurred and are properly documented to support legitimate SCCMHA authorization of funds such as billing codes and staff credential for billing services
May conduct contract compliance or other provider record audit reviews
Prepares letters of event verification findings and presents data to be easily reported to MDHHS for annual reporting
Visits provider programs on-site and reviews all necessary files and documentation for audit purposes
Establishes audit findings based on documentation and factual materials and presentations
Interprets and exercises appropriate cautions in the interpretation of audit findings for department or management staff as well as applicable providers
Alerts Department and SCCMHA management regarding serious, immediate findings
Alerts the Office of Recipient Rights of any issues that might pertain to a violation of the Michigan Mental Health Code
Prepares written audit summaries and reports
Required to meet auditing unit performance standard
Audit schedule will be contingent on residential placement workload
Applies compliance, regulatory and quality improvement standards in audit functions and tasks
Recommends policy or procedural changes as appropriate
Exercises discretion with provider data and information, including confidentiality
Recommends audit report formats and forms for SCCMHA use
Works with department and management leadership, including SCCMHA contract management, finance, operations, clinical services and compliance and quality areas to improve audit program and functional operations
Stays abreast of provider documentation and organizational compliance requirement changes
Coordinates work with recipient rights, clinical and management staff
Maintains current knowledge of system changes that impact audit work, including SCCMHA procedures, business standards, and licensing requirements
Provide specific supports and educational services to specific providers as indicated or needed to assist with and promote provider compliance
Actively monitors provider corrective action plans for completion, alerts supervisors of any needed sanctions
Facilitates persons served involvement in site audits and promotes persons served involvement in provider operations
Develops samples and other useful provider tools for site implementation to support compliance
Provides education to staff or providers either one-on-one or in a group setting to clarify audit standards
Adheres to the mission, vision, core values, and operating principles of SCCMHA at all times
Qualification
Required
Minimum of bachelor's degree in Health and Human Services
Five (5) years' experience providing support and treatment to individuals with serious mental illness or intellectual and developmental disabilities, or case management experience in mental health service delivery including service to those in licensed residential settings required
Must have demonstrated public relations, and/or community organization skills
Must have the ability to work with varied levels of organizations and strong written and verbal communication skills
Valid Michigan Driver's license with good driving record
Clinical awareness and sensitivity
General business and effective writing and editing skills
Computer competency, including word processing, spread sheets, databases, internet, E-Mail
Ability to plan and organize work and provide small group leadership
Effective oral and written communication skills, minimum at college level
Ability to organize and maintain data and information
Problem solving and mediation abilities
Ability to maintain favorable public relations and provide community leadership
Ability to exercise independent and mature judgment
Ability to maintain strict confidentiality
Ability to work independently
Hearing acuity to converse in person and on telephone
Visual acuity to observe persons served behavior, read and proofread documents and use EHR and other electronic devices
Ability to walk, stand or sit for extended periods of time
Ability to sit and drive a car for lengthy periods of time
Manual dexterity to write and to operate standard office equipment (PC, Keyboard, Copy Machine, Fax Machine, etc.)
Ability to lift and carry files and supplies at least 20 pounds
Strong interpersonal skills to interact with varied providers within the SCCMHA network as well as with other community partners
Analytical skills necessary to conduct research, analyze, and interpret complex data and identify and solve problems by proposing courses of action
Ability to plan short and long range and to manage and schedule time
Ability to handle stress in meeting deadlines and dealing with large numbers of individuals
Preferred
Master's degree preferred
Company
Saginaw County Community Mental Health Authority
Saginaw County Community Mental Health (SCCMHA) is a local, independent, governmental unit serving the greater Saginaw County area, a Community Mental Health Services Program and has been a mental health authority under contract with the Michigan Department of Health and Human Services since October 1, 1997.
201-500 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase