Title: Supervisor of Utilization Management

Starting Salary: $70,298 (Annually)

Job Summary: The Supervisor of Utilization Management promotes appropriate, effective, and efficient use of resources related to the Utilization Management Team. The scope of this position includes the supervision of Utilization Management Analysts and the review of clinical care in the OCHN provider network.

Essential Functions:

• Performs administrative and supervisory duties related to all functions of the Utilization Management Analysts.
• Monitors and evaluates specialist approvals, specialist reviews, audits, and other assigned reviews conducted by the Utilization Management Team.
• Demonstrates an applied commitment to the values as well as knowledge and skills in person served-oriented practices as well as innovations in support, service, treatment, and care practices.
• Assures adequate supervision / evaluation processes for all assigned staff members and delegate responsibilities as appropriate.
• Assures adequate orientation for new employees.
• Provides direction to individual employees on Utilization Management Team through leadership, facilitation, teaching, coordination, problem solving, conflict resolution, and coaching.
• Actively participates in the professional development of all subordinates through the Performance Management process, ensuring that all performance appraisals are completed on time.
• Oversees the development and finalization of all audit tools utilized by the team and assists in the annual creation of the audit schedule for the Utilization Management Team.
• Manage reports and data for audits and complete audit preparation.
• Leverages clinical knowledge, business rules, regulatory guidelines and policies and procedures to determine clinical appropriateness.
• Conducts prospective reviews for service authorizations as identified by OCHN.
• Conducts concurrent clinical case reviews as requested.
• Conducts retrospective reviews of service provision to ensure services were provided in the appropriate amount, scope, and duration to reasonably achieve goals as outlined in the Individualized Plan of Service.
• Provide utilization management support/coaching/training to OCHN’s provider network, as needed.
• Develop and Analyzes data and manages reports. Provides recommendations for improvement plans as well as recognition for exemplary practices.
• Participates in workgroups and committees with other OCHN Teams, such as involvement in Clinical, Quality Management, Finance, etc.
• Supervise, develop and update clinical policies, procedures, and protocols related to UM/UR.
• Participate in and guide UM Analysts, providers and hospital performance monitoring related to support and services, high risk cases, clinical audits, chart reviews, acute care, coordination, and discharges.
• Participates in management level meetings, annual goals, and updates.
• Participate in maintaining, developing, implementing, and monitoring procedures, policies, and practices required for accrediting bodies, such as NCQA and HSAG.
• Supports and consults team and Due Process Coordinator regarding any due process concerns or issues.
• Facilitate Inter-Rater Reliability testing for UM/UR Department to ensure consistency and reliability in the UM process.
• Oversee and manage Over-Under Utilization data analysis work group.
• Supports the efforts of the UM team participating in the Diversity, Equity, and Inclusion activities.
  Knowledge of mandated timeliness related to authorizations, denials and appeals from MDHHS and NCQA.
• Performs other duties as assigned.

J ob Requirements and Qualifications:

Education:

• Master's degree in mental health field.

Training Requirements (licenses, programs, or certificates):

• State of Michigan license, certification and / or registration as, Psychologist (LLP, LP), Social Worker (LMSW), Counselor (LPC), Marriage and Family Therapist (LMFT).
• CADC, CAADC, or Development Plan preferred.
• For children’s services - maintain/attain 24 hours annually of child-specific training.

Experience Requirements:

• 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.
• Preference for experience in a supervisory/leadership role.
• Preference for experience in the OCHN network.

Knowledge Requirements:

• Knowledge of the Michigan Mental Health Code.
• Understanding of Medicaid rules, regulations, and Michigan Medicaid Provider Manual.
• Understanding of utilization management.
• Preference for knowledge of the OCHN Utilization Management Manual and Protocols.

Job Specific Competencies/Skills:

• Demonstrated effective interpersonal skills.
• Demonstrated ability to work effectively in a team environment.
• Demonstrated effective written and oral communication skills.
• Demonstrated effective computer skills.

In addition, the following are preferred competencies:

• 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.

Oakland Community Health Network's Core Competencies:

• Interacting with others in a way that gives them confidence in one’s intentions and those of the organization; demonstrating loyalty to the organization and its mission and values; maintaining social, ethical, and organizational norms; firmly adhering to codes of conduct and ethical principles. (Integrity/Building Trust)
• Making customers and their needs a primary focus of one’s actions; developing and sustaining productive customer relationships, recognizing that the ultimate customer is the person served. (Customer Focus)
• Actively identifying new areas for learning; regularly creating and taking advantage of learning opportunities; using newly gained knowledge and skill on the job and learning through their application. (Continuous Learning)
• Setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence in addition to consciously adopting organizational standards of excellence. (Work Standards)
• Clearly conveying information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message. (Communication)

Additional Information:

(Travel required, physical requirements, on-call schedules, and so on):

• 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.
• Work performed primarily in an office environment.
• Hybrid (onsite/remote) work schedule available.
• The ideal candidate must be able to complete all physical requirements of the job with or without a reasonable accommodation.

OCHN is committed to building a diverse team and fostering an inclusive and equitable culture. We are proud to be an equal opportunity employer that embraces and encourages our employees' differences. This includes (but is not limited to) ability, age, color, family type, gender expression and identity, individual expression, medical conditions, national origin, pregnancy, race, religion, sexual orientation, veteran status, and all other diverse and wonderful characteristics.