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)
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:
KNOWLEDGE, SKILLS, AND ABILITIES (KSA's):
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, , LMHC, LPC, LLP or PhD.
A Valid State of Michigan Driver's License with a safe and acceptable driving record.
WORKING CONDITIONS:
Work is usually performed in an office setting but requires the employee to drive to different sites throughout Wayne County and the State of Michigan. This position can work remotely with supervisory approval. Currently this position is primarily a remote position.
This description is not intended to be a complete statement of job content, rather to act as a general description of the essential functions performed. Management retains the discretion to add or change the position at any time.
Please Note: DWIHN requires proof of being fully vaccinated for COVID-19 as a condition of employment. Medical or religious accommodation or other exemptions that may be required by law, will be approved when properly supported. Further information will be provided during the recruitment process.
The Detroit Wayne Integrated Health Network is an Equal Opportunity Employer