Utilization Management Director leads and directs the utilization review staff and function for a healthcare facility. Determines policies and procedures that incorporate best practices and ensure effective utilization reviews. Being a Utilization Management Director manages and monitors both concurrent reviews to ensure that the patient is getting the right care in a timely and cost-effective way and retrospective reviews after treatment has been completed. Provides analysis and reports of significant utilization trends, patterns, and impacts to resources. Additionally, Utilization Management Director consults with physicians and other professionals to develop improved utilization of effective and appropriate services. Requires a master's degree. Typically reports to top management. Typically requires Registered Nurse(RN). The Utilization Management Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be a Utilization Management Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)
CMHA-CEI is a Michigan Certified Bronze Level Veteran Friendly Employer and we encourage active military service member, veterans, and their family member to apply.
Responsibilities: Under the general administrative supervision of the Quality Improvement and Utilization Management Coordinator, responsible for maintaining the regulatory quality improvement initiatives for Community Mental Health Authority of Clinton-Eaton-Ingham Counties (CMHA-CEI), facilitating utilization of staff and program resources through performance of utilization review and coordination of care functions. Retrieves and analyzes data from a number of sources and provides guidance, training, and consultation to CMHA-CEI staff in the use, interpretation, and critical analysis of data; is responsible for working cooperatively with clinical staff, program management staff, finance and quality improvement components. Responsible for carrying out all activities of the office in such a manner that fulfills CMHA-CEI’s mission, policies, and procedures.
Requirements: Possession of a Bachelor's or Master's degree in Social Work, Psychology, or related field from an accredited college or university is required. Must have at least three (3) years of work experience in human services; preferably working within utilization or quality improvement areas. Two (2) years’ experience as a practicing Mental Health Professional with experience in reviewing clinical practice against criteria required. Must be able to exercise independent judgment and confidentiality. Ability to communicate accurately and effectively both in writing and verbally is required. Must have proven abilities in problem-solving. Knowledge of multiple regulations, standards, policies, and requirements pertaining to clinical documentation, coding, and billing required. Must have ability to accurately interpret and implement regulatory standards and legal requirements. Possession of a valid Michigan Driver's License and access to reliable means of transportation for job related use is required.
Conditional Employment Requirements: Employment offers for this position will be contingent upon the results of a background verification and credentialing procedure consisting of: Michigan State Police clearance check, verification of an acceptable driving record, educational background check, and verification of an acceptable work history. Must pass a pre-employment drug screen.
To Apply: Applicants must submit an employment application. Resumes cannot be substituted for the employment application. CMHA-CEI’s promotion of diversity is fueled by the desire to seek equality of opportunity for all persons. CMHA-CEI is an Equal Opportunity Employer and a Drug Free Workplace.
Salary/Hours: Starting salary $23.87 - $27.77 per hour, 40 hours per week. Must be able to work some evening hours.
Location: Quality, Customer Service, and Recipient Rights, Lansing, MI.
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