About the role

  • Promotes appropriate, effective, and efficient use of resources via concurrent reviews of acute care authorizations
  • Analyzes records to determine legitimacy of admission, treatment, and length of stay in acute care
  • Compares inpatient medical records to established criteria and confers with OCHN provider personnel as well as personnel in acute care and other professional staff
  • Determines continued stay review dates according to established clinical protocols and diagnostic criteria
  • Conducts continued stay reviews and determines continued authorization status
  • Coordinates with OCHN and acute care providers to ensure appropriate communication and discharge planning occurs
  • Accountable for timely and comprehensive review of clinical data with concise documentation, decisions and rationale
  • Leverages clinical knowledge, business rules, regulatory guidelines and policies and procedures to determine clinical appropriateness for acute care authorizations
  • Participate in workgroups and committees with other OCHN Teams

Requirements

  • Master's degree in mental health field
  • 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)
  • Minimum of five (5) years relevant experience providing services to Adults with Mental Illness, Intellectual or Developmental Disabilities, Substance Use Disorder and/or children with serious emotional disturbance or intellectual or Development Disabilities
  • Knowledge of the Michigan Mental Health Code
  • Understanding of Medicaid rules and regulations
  • Understanding of utilization management
  • Preference for knowledge of the OCHN Utilization Management Manual and Protocols
  • Demonstrated effective interpersonal skills
  • Demonstrated ability to work effectively in a team environment
  • Demonstrated effective written and oral communication skills
  • Demonstrated effective computer skills

Benefits

  • Hybrid (onsite/remote) work schedule available
  • Must have available means of transportation to and from OCHN and for required offsite meetings or site visits
  • Must be available for meetings and events which may occur outside of standard office hours

Job title

Utilization Review Analyst

Job type

Experience level

Mid levelSenior

Salary

$56,165 - $70,206 per year

Degree requirement

Postgraduate Degree

Location requirements

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