Utilization Management Lead, Clinical Oversight & Quality

Oakland-Community-Health-Network; Troy (MI); Hybrid; USD 70,000 - 88,000; Full time

Job summary

Oakland Community Health Network seeks a Supervisor of Utilization Management to lead the UM team, oversee clinical analysts, ensure compliant utilization management practices, and drive quality improvement across the provider network.

Responsibilities include supervising staff, guiding audits, developing policies, and coordinating with providers to optimize care and resource use within regulatory standards.

Qualifications

• Master's degree in mental health required.
• Three years of relevant post-graduate experience.

Responsibilities

• Provide administrative oversight for UM Clinical Analysts and ensure policy compliance.
• Lead audits, quality improvement initiatives, and data-driven decision making.
• Develop, implement, and maintain UM policies, procedures, and protocols.
• Provide training and coaching to UM staff and provider network.
• Monitor authorization decisions and performance metrics for timely, appropriate UM actions.

Skills

Leadership

Coaching

Communication

Data analysis

Education

Master's degree in mental health

Job description

Oakland Community Health Network seeks a Supervisor of Utilization Management to lead the UM team, oversee clinical analysts, ensure compliant utilization management practices, and drive quality improvement across the provider network.

Responsibilities include supervising staff, guiding audits, developing policies, and coordinating with providers to optimize care and resource use within regulatory standards.