Utilization Review Specialist (26-144)

Kent County Cmh Authority; Grand Rapids (MI); Remote; USD 63,000 - 84,000; Full time

Benefits offered by this job

Health insurance

Dental and vision insurance

Paid holidays

Generous PTO

Tuition reimbursement

Professional development

License reimbursement

401(k) retirement plan

Life insurance

Disability insurance

Loan repayment opportunities

Job summary

Kent County Cmh Authority is seeking a Utilization Review Specialist to perform reviews for I/DD, mental health, and SUD services. You will assess treatment plans and identify discharge barriers, helping transition care to appropriate intensity settings.

The role is full-time and remote with occasional local travel within the Kent County area. Strong clinical experience and cross-functional communication are essential for success.

Qualifications

• Fully licensed LMSW/LMFT/LPC; or LLP with 5 years clinical experience (2 post-licensure preferred)
• RN in Michigan with at least 2 years clinical experience in behavioral health
• Ability to interpret clinical summaries and apply medical necessity criteria
• Knowledge of psychological, emotional, and sociological assessment and diagnosis
• Professional ethics and standards of practice; ability to handle multiple projects
• Excellent verbal and written communication; work well under stress

Responsibilities

• Perform utilization review of I/DD, mental health, and SUD intensive treatment services.
• Assess current or proposed treatment plans to identify barriers to discharge.
• Assist in transitioning care to appropriate intensity service setting.
• Review and document utilization decisions; communicate outcomes to teams.

Skills

Clinical interpretation

Effective communication

Multicultural environment

Time management

Fast-paced work

Data entry

Word processing

Spreadsheet proficiency

Education

LMSW/LMFT/LPC license or LLP

RN license (Michigan)

Tools

Word processing

Excel

Email

Database management

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Grand Rapids, MI, US

FTE: Full-time, exempt

Unit: UAW

Compensation: $63,102.73-$83,647.81 The Final job offer is based on several factors (internal equity, skills, education, experience, and credentials).

Attractive Benefits Package

• Four health insurance plans
• 100% employer paid dental and vision insurance plans
• 13 paid holidays
• Generous PTO
• Professional development
• Tuition reimbursement
• Professional License reimbursement
• Defined contribution retirement plan
• Employee Assistance program
• Life and voluntary life insurance options
• Short and Long term disability
• Approved site for loan forgiveness (based on position and department): NHSC, STAR Loan Repayment, Behavioral Health Loan Repayment, MI Kids Now Loan Repayment and much more!

Network180 employees make a difference in people’s lives every day, making our community a better place to live. We are the behavioral health community organization responsible for the delivery of mental health, substance abuse treatment coordination, and developmental disabilities services for Kent County. We need individuals who are passionate about making a difference by helping others.

We are seeking a Utilization Review Specialist to perform utilization review of intellectual and developmental disability services (I/DD), mental health, and substance use disorder (SUD) intensive treatment services. This position will assess individuals’ current or proposed treatment plan to identify and address potential barriers to discharge and assist in transitioning care to an appropriate intensity service setting.

This position is full-time, Monday through Friday, from 8:00am to 4:30pm. There are no weekends, on-call or holiday requirements for this position. While the position is remote, the individual in this position will have occasional travel within the Kent County community and surrounding areas.

MINIMUM QUALIFICATIONS:

• Fully licensed Master of Social Work (LMSW), fully licensed Marriage and Family Therapist (LMFT), fully licensed Professional Counselor (LPC); or limited licensed Psychologist (LLP), with at least five (5) years of clinical experience (at least two [2] years of clinical experience post-licensure preferred); or
• Registered Nurse (RN) in Michigan with at least two (2) years of clinical experience in the delivery of behavioral health services.
• Ability to interpret clinical summaries and apply established medical necessity criteria to make utilization decisions.
• Thorough working knowledge of the practices and principles of psychological, emotional, and sociological assessment and diagnosis.
• Thorough working knowledge of professional ethics and standards of practice.
• Ability to handle multiple projects simultaneously.
• Lived experiences with mental illness/developmental disabilities/substance use disorders valued.
• Computer skills including word processing, spreadsheets, email, database management, and data entry skills.
• Ability to work in a fast-paced environment.
• Ability to communicate clearly and concisely in stressful situations.
• Excellent communication skills, both verbal and written.
• May need to work an occasional weekend day or holiday depending on volume of utilization reviews scheduled to be completed.
• Ability to work effectively in a multicultural environment and skills and capabilities of bridging language/cultural barriers to Network180 services within diverse communities.

PREFERRED QUALIFICATIONS:

• Experience performing utilization review and/or providing clinical services in an intensive treatment setting.
• Qualified Intellectual Disability Professional (QIDP; requires one-year full time experience working with persons with developmental disabilities and appropriate license/degree per State of Michigan), preferred for positions reviewing intellectual and developmental disability services.
• Child Mental Health Professional (CMHP; requires one year of experience in the examination, evaluation, and treatment of minors and their families and appropriate license/degree per State of Michigan), preferred for positions reviewing children’s services.

Job interviews are being conducted in person or via the internet. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed on the job description are representative of the knowledge, skill, and/or ability required. For a detailed job description and responsibilities please review the job description. Network180 is an Equal Opportunity Employer. Network180 participates in E-Verify.

Network180 is a drug and alcohol-free workplace, which includes the prohibition of recreational marijuana use. Successful completion of a drug screen is part of our background check process.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Assistance with the application process may be requested through the Human Resources Department at 616 336-3909 or [e-mail] .

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.