Behavioral Health UM Analyst - Hybrid

Oakland-Community-Health-Network; Troy (MI); Hybrid; USD 56,000 - 70,000; Full time

Job summary

Oakland Community Health Network seeks an experienced Utilization Management Clinical Analyst to conduct prospective reviews of behavioral health services, applying clinical expertise and evidence-based criteria. The role ensures medical necessity, appropriate level of care, and timely decisions in collaboration with providers and internal teams.

Responsibilities include retrospective reviews, policy development, and ongoing quality improvement to support person-centered care and regulatory

Qualifications

• Master’s degree in the mental health field or relevant discipline.
• Current, unrestricted Michigan license in one of: LLP/LP, LMSW, LPC, LMFT, RN, and CDTP eligibility (24 hours annual training).
• Minimum of three (3) years of post-graduate clinical experience with adults and/or children in behavioral health or related fields.

Responsibilities

• Assess medical necessity and clinical appropriateness of behavioral health service requests.
• Analyze clinical information to determine level of care, duration, and intensity.
• Ensure compliance with Medicaid, PIHP, and state/federal regulations and provider manuals.
• Conduct retrospective utilization reviews to evaluate documentation and treatment alignment with IPOS.
• Contribute to policy development, protocols, and quality improvement in utilization management.
• Collaborate with clinical teams, providers, and stakeholders to ensure coordinated care.
• Participate in committees and workgroups to support system-wide clinical quality.

Skills

Team collaboration

Treatment understanding

Communication skills

Clinical decision-making

Education

Master’s degree in mental health

Job description

Oakland Community Health Network seeks an experienced Utilization Management Clinical Analyst to conduct prospective reviews of behavioral health services, applying clinical expertise and evidence-based criteria. The role ensures medical necessity, appropriate level of care, and timely decisions in collaboration with providers and internal teams.

Responsibilities include retrospective reviews, policy development, and ongoing quality improvement to support person-centered care and regulatory