Director of Utilization Management

Job description

Director of Utilization Management

Under the general supervision of the Vice President of Clinical Operations for the Detroit Wayne Integrated Health Network (DWIHN), the 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 coordinates activities with other department directors to ensure utilization management tasks are integrated with other Department functions.
• Assists the Chief Medical Officer (CMO) in facilitating the Utilization Management Committee and participates on other DWIHN committees such as Quality Assurance.
• Performs related duties as assigned.

REQUIRED EDUCATION:

A Master’s Degree in Social Work, Psychology, Counseling, Nursing, the Human Services, the Social Services, or a related field.

REQUIRED EXPERIENCE:

Ten (10) years of experience in the mental health field.

AND

At least five (5) years of managed care experience applying UM and utilization review principles.

REQUIRED LICENSE(S).

A Valid State of Michigan clinical licensure: RN, LMSW, LMHC, LPC, LLP or PhD.
A Valid State of Michigan Driver’s License with a safe and acceptable driving record.

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