Hybrid Behavioral Health Utilization Review Analyst

Oakland Community Health Network; Troy (MI); Hybrid; USD 56,165 - 70,206; Full time

Job summary

Oakland Community Health Network is seeking an experienced Utilization Review Analyst in Troy, MI, to conduct prospective, concurrent, and retrospective reviews for behavioral health services. The role emphasizes medical necessity determinations, authorizations, and cross-functional collaboration to support timely care transitions.

You will review clinical documentation, apply criteria, and maintain compliance with the Michigan Medicaid Provider Manual and organizational standards.

Qualifications

• Master's degree in a mental health field is required.
• Strong interpersonal and collaboration skills are essential.
• Excellent written and verbal communication abilities are expected.

Responsibilities

• Conduct prospective, concurrent, and retrospective reviews to determine medical necessity and authorize services.
• Collaborate with providers, hospitals, and treatment teams to support timely decisions and transitions.
• Document reviews and decisions accurately within required timeframes.
• Apply evidence-based utilization criteria and clinical protocols for authorization decisions.
• Ensure compliance with Michigan Medicaid Provider Manual and organizational policies.
• Participate in quality improvement initiatives and provider collaboration activities.

Skills

Interpersonal skills

Negotiation

Communication

Project management

Education

Master's degree in mental health field

Job description

Oakland Community Health Network is seeking an experienced Utilization Review Analyst in Troy, MI, to conduct prospective, concurrent, and retrospective reviews for behavioral health services. The role emphasizes medical necessity determinations, authorizations, and cross-functional collaboration to support timely care transitions.

You will review clinical documentation, apply criteria, and maintain compliance with the Michigan Medicaid Provider Manual and organizational standards.