Clinical Utilization Management Specialist

DETROIT WAYNE Integrated HEALTH Network; Detroit (MI); Remote; USD 75,000 - 110,000; Full time

Job summary

Detroit Wayne Integrated Health Network (DWIHN) seeks an experienced Clinical Specialist – Utilization Management to oversee UM reviews and care coordination across a network of providers in Wayne County and Michigan.

Reporting to the Director of Utilization Management, the role emphasizes medical necessity criteria, treatment plan authorization, care level determinations, and collaboration with health homes and community partners to ensure high-quality, coordinated behavioral health services.

Qualifications

• Master’s degree in a relevant field is required.
• Four years of professional experience in behavioral healthcare.
• A valid Michigan clinical license (RN, LMSW, LMHC, LPC, LLP or PhD) required.

Responsibilities

• Provides utilization management and review of services for DWIHN clients.
• Offers clinical expertise and consultation for care coordination teams.
• Facilitates integrated care delivery with providers and community partners.
• Authorizes treatment plans and applies medical necessity criteria.
• Monitors and evaluates provider treatment plans for quality and effectiveness.
• Performs data gathering and analysis for outcomes and reporting.

Skills

Utilization management

Care coordination

Clinical consultation

Medial necessity criteria

Quality improvement

Education

Master’s degree in Human Services / Social Services / Nursing / Public Health / Healthcare Administration

Job description

Detroit Wayne Integrated Health Network (DWIHN) seeks an experienced Clinical Specialist – Utilization Management to oversee UM reviews and care coordination across a network of providers in Wayne County and Michigan.

Reporting to the Director of Utilization Management, the role emphasizes medical necessity criteria, treatment plan authorization, care level determinations, and collaboration with health homes and community partners to ensure high-quality, coordinated behavioral health services.