Utilization Review Supervisor (PCN 1547)
$70,298–$87,873 year
On-siteTroy, Michigan, United States
Job Summary
Conduct comprehensive utilization reviews of clinical care, admission legitimacy, and treatment length of stay for acute care and State facilities within the OCHN provider network. Supervise Utilization Review Analysts by evaluating specialist approvals, audits, and assigned reviews while providing direction through coaching, conflict resolution, and performance management. Manage data analysis for audits, develop clinical policies and protocols, and coordinate with providers to ensure appropriate discharge planning. Facilitate inter-rater reliability testing, maintain accreditation standards, and participate in workgroups for quality management and benefits initiatives. Requires a Master's degree in mental health, state license as a Psychologist, Social Worker, Counselor, or Marriage and Family Therapist, and minimum five years of relevant experience.
Required Qualifications
- Master's degree in mental health field
- State of Michigan license, certification and / or registration as, Psychologist (LLP, LP), Social Worker (LMSW), Counselor (LPC), Marriage and Family Therapist (LMFT)
- Minimum of 5 years relevant experience providing services to persons with Mental Illness, Intellectual or Developmental Disabilities, Substance Use Disorder and/or Serious Emotional Disturbance
- Knowledge of the Michigan Mental Health Code
- Understanding of Medicaid rules, regulations, and Michigan Medicaid Provider Manual
- Understanding of utilization review
- Must have available means of transportation to and from OCHN and for required offsite meetings or site visits
- Must be available for meetings and events which may occur outside of standard office hours
Desired Qualifications
- CADC, CAADC, or Development Plan preferred
- For children's services - maintain/attain 24 hours annually of child-specific training
- Preference for experience in a supervisory/leadership role
- Preference for experience in the OCHN network
- Preference for knowledge of the OCHN Utilization Review Manual and Protocols
- Demonstrated experience in quality assurance and quality monitoring
- Demonstrated experience in the application of medical necessities
- Demonstrated experience in data analysis and outcome measurement
- Demonstrated understanding of the application and outcome measurement of Evidence Based Practices
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