Hybrid Utilization Management Clinician (Behavioral Health)

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

Job summary

Oakland Community Health Network in Troy, MI is seeking a full-time Utilization Management Clinical Analyst to lead prospective reviews of authorization requests for behavioral health services. You will apply clinical expertise to determine medical necessity and appropriate level of care, aligning with Medicaid guidelines and the Michigan Mental Health Code.

The role emphasizes collaboration with internal teams and providers, retrospective reviews, policy development, and continual quality

Qualifications

• Master’s degree in mental health field is required.
• Current, unrestricted State of Michigan professional license in one of: LLP/LP, LMSW, LPC, LMFT, RN.
• Minimum of three years of relevant post-graduate clinical experience with adults and youth in behavioral health or related fields.

Responsibilities

• Perform prospective reviews to determine medical necessity and level of care for behavioral health services.
• Analyze complex clinical information to justify authorization decisions.
• Ensure compliance with Medicaid, PIHP, and Michigan regulations and organizational policies.
• Conduct retrospective utilization reviews to assess evidence of necessity and quality of care.
• Develop and validate utilization management policies and tools for ongoing improvement.
• Collaborate with internal teams, providers, and community partners to coordinate care and discharge planning.

Skills

Teamwork

Clinical terminology

Communication skills

Evidence-based practice

Education

Master’s degree in mental health field

Job description

Oakland Community Health Network in Troy, MI is seeking a full-time Utilization Management Clinical Analyst to lead prospective reviews of authorization requests for behavioral health services. You will apply clinical expertise to determine medical necessity and appropriate level of care, aligning with Medicaid guidelines and the Michigan Mental Health Code.

The role emphasizes collaboration with internal teams and providers, retrospective reviews, policy development, and continual quality