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Provider Network UM Administrator

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.

The Provider Network Utilization Management Administrator is responsible for ensuring compliance with DWIHN policies and procedures and Federal, State and local government regulations. Responsible for managing clinical projects and serving as team lead for DWIHN team members assigned to said projects. This includes strategic and operational leadership in clinical development planning, resource management, staff mentoring, project operational support, and Utilization Management planning, and decision-making.

PRINCIPAL DUTIES AND RESPONSIBILITIES

• Assists the UM Director in the development and implementation of clinical operations plans. Paying particular attention to utilization trends and the provision of timely, efficient, and effective service by providers.
• Facilitates regular meetings to ensure staff is kept well informed.
• Coordinates with the Detroit Wayne Integrated Health Network (Network) outside clinicians, Medical Director, and/or providers regarding utilization and client specific issues.
• Serves on DWIHN committees and represents DWIHN at meetings and on committees as assigned.
• Develops and/or evaluates Utilization Management and Customer Service policies, procedures, operations, and programs and implements changes as needed.
• Works with staff and agencies in the development of joint procedures, program planning, and resolution of problems.
• Monitors changes in Federal, State and local rules and regulations related to behavioral health.
• Develops and oversees management of Utilization Management and Customer Service operations budgets as they pertain to specific projects, forecasts, and variances.
• Sits on the DWIHN Clinical/Quality Advisory Committee.
• Accepts additional responsibilities and duties as assigned Provider Network Utilization Management Administrator Position Description July, 2018.
• Supports DWIHN in achieving its mission while maintaining confidentiality and ethical and professional standards.
• Provides after-hours on-call coverage for clinical and customer service issues

QUALIFICATIONS
Education:
Master’s Degree in Psychology, Social Work, Counseling, Business Administration, Health Care Administration, Nursing or Education.

Training Requirements (licenses, programs, or certificates):
LMSW, LLP, LPC, or equivalent as dictated by specific degree.

Experience:
Three (3) years of experience in health care industry with at least one (1) year of management experience.

KNOWLEDGE, SKILLS, AND ABILITIES (KSA’S)/CORE COMPETENCIES

• Leadership skills and the ability to develop and maintain effective and harmonious relationships with a wide variety of individuals including community members, employees, providers, community partners and agencies and County Officials.
• Knowledge of clinic operation functions, managed care systems and fee for service systems as well as Medicaid and Medicare reimbursement practices.
• Proficient in team building, conflict resolution, group interaction, project management.
• Proficient in Microsoft Word, PowerPoint, and Excel.

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