Utilization Management Lead – Hybrid Health Services

Oakland-Community-Health-Network; Troy (MI); Hybrid; USD 83,000 - 104,000; Full time

Job summary

Oakland Community Health Network is seeking a Manager of Utilization Management to lead UM operations, ensure compliant, efficient, and cost-effective delivery of services across the service network.

You will collaborate with internal teams, providers, and community stakeholders to optimize utilization, monitor performance, and drive improvement initiatives while supporting accreditation and regulatory requirements.

Qualifications

• Master's degree in mental health field required.
• State of Michigan license, certification and/or registration as Psychologist (LLP, LP), Social Worker (LMSW), Counselor (LPC), Marriage and Family Therapist (LMFT) or Nurse (RN).
• 3–5 years of relevant post-graduate clinical experience in adults with mental illness, developmental disabilities, or substance use disorders; children with serious emotional disturbance.
• Experience in CMHSP, PIHP, MCO, hospital, or behavioral health setting.

Responsibilities

• Supervise and develop Utilization Management staff.
• Oversee daily UM operations ensuring compliance with policies, contracts, accreditation, and regulations.
• Manage service authorization, utilization review, and monitoring to ensure clinical appropriateness and cost-effectiveness.
• Analyze utilization, access, quality, and cost data to identify trends and drive improvement initiatives.
• Monitor performance indicators and implement corrective actions when targets are missed.
• Develop and maintain UM policies, procedures, and tools in collaboration with leadership.
• Prepare and present utilization reports and recommendations to leadership and stakeholders.
• Collaborate with providers to address utilization concerns and implement improvement plans.

Skills

Interpersonal skills

Team collaboration

Communication

Computer skills

Education

Master's degree in mental health

Job description

Oakland Community Health Network is seeking a Manager of Utilization Management to lead UM operations, ensure compliant, efficient, and cost-effective delivery of services across the service network.

You will collaborate with internal teams, providers, and community stakeholders to optimize utilization, monitor performance, and drive improvement initiatives while supporting accreditation and regulatory requirements.