Access-Utilization Manager

The Access-UM Manager position is a program and administrative management position providing operational oversight and direction for behavioral health services utilization across the region respective to the Region 10 PIHP Access Unit and Utilization Management Unit. An employee at this level is required to perform, among others, the following essential duties:

• Provide oversight of Access-UM clinical operations, including backup to the Lead Clinician and clinical staff

• Provide direction and supervision of all Access-UM clinical staff and program support staff

• Monitor and ensure daily staff coverage, including on-call after-hours coverage

• Ensure completion of Access Management System reports

• Provide oversight of regional Utilization Management (UM) and Utilization Review (UR) activities across the CMH and SUD provider networks, including case finding and case record review, protocol updates, and quarterly and end of year activity reports

• Assist in the development and periodic evaluation of regional clinical practice guidelines

• Facilitate and support provider network implementation and sustainment activities pertaining to MDHHS evidence-based practices and UM/UR guidance documents

• Complete staff performance reviews and staff development plans

• Develop Access-UM Staff Meeting Agenda and conduct staff meetings

• Assist with developing and implementing regional Utilization Management Program Plan

• Provide lead clinical support and participation on Region 10 committees (UMC, IPLT, SERC), including backup to the UMC Chair

• Participate on other committees and work groups as assigned

• Provide SME input and representation on HSAG audit Standards and contract monitoring

• Serve as backup to the CCO on the state-wide UM Directors Group

• Provide technical guidance on clinical issues related to regional Credentialing and Privileging policy standards and Grievance and Appeal reviews and policy standards, * When applying, be sure to include evidence that the minimum qualifications are met (resume, copy of license, copy of educational transcripts, description of years of experience, skill-based experience/training, letters of reference, etc.).

• This position will be hired as employment-at-will.

• Any offer of employment is contingent upon a Criminal Background Check, as well as a Five Panel Drug Screen.

• Region 10 PIHP embraces an employment environment that promotes recovery and discovery, a person-centered approach to treatment/services, and cultural competence. An employee in this or any position is expected to support the employment environment.

• Master’s degree in social work or related human service field

• Demonstrated ability to utilize clinical source documents: American Society of Addiction Medicine (ASAM) and Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (DSM-5)

• Knowledge of evidence-based and best practices within behavioral health services

• Proficiency and experience working on an Electronic Health Record Systems.

• Minimum three years’ experience with behavioral health services provision

• Two years of experience supervising staff

• Experience working at PIHP and / or CMH

• Basic knowledge of State of Michigan Medicaid Provider Manual (MMPM)

• Highly organized

• Access to transportation

• Valid State of Michigan Driver’s License, * Experience as PIHP Access Center Clinician

• Three to five years’ experience in public behavioral health

• Certified Advanced Alcohol and Drug Counselor (CAADC)

• Experience utilizing Peter Chang Enterprise (PCE) Electronic Health Record

Pulled from the full job description

• Health insurance
• Paid time off
• Paid holidays, Overview: Region 10 is committed to being a premier employer by enhancing the lives of our team and supporting their growth as people and professionals. Sign on bonus of $6,000 available. We provide competitive wage scales that reward experience and performance, ongoing career development and training opportunities, excellent health coverage, generous paid time off with additional performance-based incentives, 13 paid holidays, flexible scheduling, and a comprehensive benefit program.