Director of Utilization Management
Agency Name: Detroit Wayne Integrated Health Network
Agency Contact: DWIHN Human Resources
- Position Type: Full Time
- Job Type: Permanent
- County: Wayne
- Salary Range: Commensurate with Experience per Year
- Send applications to: https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=46595d30-595a-4b2b-9a9e-936f8beff433&ccId=19000101_000001&type=MP&lang=en_US
- Please include your resume when applying.
Under the general supervision of the Chief Clinical Officer for the Detroit Wayne Integrated Health Network (DWIHN), the DWIHN Director of Utilization Management is responsible for managing the day to day operations of the Utilization Management Program and staff. This position oversees all phases of development, organization, planning and implementation of Utilization Management projects, initiatives, work flows and processes to enhance quality-driven outcomes. The Director is expected to monitor activities that include overutilization, underutilization, standardization, implementation of new technology and assurances that DWIHN values are met.
PRINCIPAL DUTIES AND RESPONSIBILITIES
• Develops and oversees processes and procedures to ensure department-wide compliance with contractual, regulatory (Federal/State) and accreditation entities.
• Serves on the executive management team and coordinate activities with other department directors to ensure the utilization management tasks are integrated with other Departments’ functions.
• Assists the Chief Medical Officer (CMO) in facilitating the Utilization Management Committee and participates on other DWIHN committees such as Quality Assurance, as appropriate.
• Works closely with the Chief Medical Officer to ensure timely and accurate reviews that result in medically necessary, appropriate, efficient and cost effective services.
• Monitors and tracks key performance indicators to independently identify over/under utilization patterns and/or deviation from expected results.
• In collaboration with the CMO and CEO, assists in identifying and then implementing strategies to correct trends of either over or under utilization.
• Prepare statistical and narrative utilization management reports for submission to the CEO on utilization patterns, expenditures by area and revenue stream, demographics of service delivery and trending of expenditures by program.
• Establishes and amends, as necessary, a reporting system for Manager of Comprehensive Networks, Direct Service Providers, Substance Use Disorder Providers and other stakeholders.
• Oversees UM portion of all readiness reviews (i.e External Quality Review Organization (EQRO) and Michigan Department of Community Health).
• Develops and monitors budget for the Department while ensuring sufficient resources are assigned to meet the utilization management goals.
• Serves as the liaison for DWIHN concerning utilization management activities, including participation in external meetings and coordination with external entities.
• Works with staff to develop clear and concise development plans to ensure the advancement of the utilization management goals.
• Develops formal department-specific new staff orientation and training programs.
• Conducts regular staff meetings for communication of continuous quality improvement, assessment of workplace issues and open forum for staff.
• Master’s degree in relevant field.
• Bachelor’s degree required in Social Work, Psychology, Sociology or related human services area.
Training Requirements (licenses, programs, or certificates):
• Current valid Michigan clinical licensure (RN, LICSW, LMHC, LPC, or PhD)
• Qualified Mental Health Professional (QMHP) certification or the ability to obtain preferred.
• Minimum of 10 years’ experience in the mental health field.
• Seven (7) years of managed care experience applying UM and utilization review principals.
• Minimum five (5) years working in human services. Preferred experience in conducting screenings, intakes, and authorizations or worked in an access center.
• Experience must also include providing access authorization and overrides, utilization review Technical Assistance in new evidenced based practices. Experienced in the field of substance abuse
KNOWLEDGE, SKILLS, AND ABILITIES (KSA’S)/CORE COMPETENCIES
• Understanding of case management principles and strategies. Able to implement solutions that directly influence quality of care.
• Knowledge of Medical Necessity Criteria for Behavioral Health services, American Society of Addiction Medicine Patient Placement Criteria (ASAM) and the Federal Confidentiality Regulations, 42 CFR, Part 2
• Knowledge of and strong belief in recovery-oriented systems of care.
• Knowledge of relevant standards and regulations of the State of Michigan; knowledge of the Michigan Department of Community Health and the Detroit-Wayne Community Mental Health Authority.
• Advanced demonstrated problem-solving skills and independent problem solving to overcome barriers and meet deadlines.
• Advanced experience and expertise in communication, writing and composing, editing, finalizing and producing and delivering work products such as protocols, bulletins and directives for the field
• Ability to effectively speak before groups such as physicians, senior administrators and other behavioral health care professionals.
• Well-developed data analytic skills and skill at effectively communicating the results of data analysis.
• Knowledge of various treatment modalities/programs.
• Ability to handle co-occurring and substance use treatment services.
• Openness to the emerging workforce in community mental health, including people with lived experience, their family members, allies and fictive kin.
• Healthy respect for the needs and interest of the individuals who receive services.
• Must be able to use multiple clinical systems and demonstrate advanced desktop technology skills.