Utilization Review Specialist (26-144)
About The Position
Network180 is the behavioral health community organization responsible for coordinating mental health, substance abuse treatment, and developmental disability services in Kent County. The Utilization Review Specialist reviews intellectual and developmental disability (I/DD), mental health, and substance use disorder (SUD) intensive treatment services. The role assesses current or proposed treatment plans to identify potential barriers to discharge and support transitions to services at an appropriate intensity. This is a full-time, exempt, remote position in the Utilization Management department. The schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m. Occasional travel within Kent County and surrounding areas is required. Although there are no regular weekend, on-call, or holiday requirements, an occasional weekend day or holiday may be needed depending on the volume of reviews scheduled.
Requirements
- One of the following 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 years of clinical experience; or Michigan-registered Nurse (RN) with at least two years of clinical experience delivering behavioral health services.
- Ability to interpret clinical summaries and apply established medical necessity criteria to make utilization decisions.
- Thorough working knowledge of psychological, emotional, and sociological assessment and diagnosis practices and principles.
- Thorough working knowledge of professional ethics and standards of practice.
- Ability to handle multiple projects simultaneously.
- Computer skills in word processing, spreadsheets, email, database management, and data entry.
- Ability to work in a fast-paced environment.
- Ability to communicate clearly and concisely in stressful situations.
- Excellent verbal and written communication skills.
- Ability to work effectively in a multicultural environment and bridge language and cultural barriers to Network180 services within diverse communities.
- May need to work an occasional weekend day or holiday depending on the volume of utilization reviews scheduled.
Nice To Haves
- At least two years of clinical experience post-licensure is preferred for the licensed social work, marriage and family therapist, professional counselor, or limited licensed psychologist pathway.
- Lived experience with mental illness, developmental disabilities, or substance use disorders is valued.
- Experience performing utilization review and/or providing clinical services in an intensive treatment setting.
- Qualified Intellectual Disability Professional (QIDP) qualification, which requires one year of full-time experience working with people with developmental disabilities and the appropriate Michigan license or degree, preferred for positions reviewing I/DD services.
- Child Mental Health Professional (CMHP) qualification, which requires one year of experience examining, evaluating, and treating minors and their families and the appropriate Michigan license or degree, preferred for positions reviewing children’s services.
Responsibilities
- Perform utilization review of intellectual and developmental disability, mental health, and substance use disorder intensive treatment services.
- Assess individuals’ current or proposed treatment plans.
- Identify and address potential barriers to discharge.
- Assist in transitioning care to a service setting with an appropriate intensity.
- Interpret clinical summaries and apply established medical necessity criteria to make utilization decisions.
Benefits
- Four health insurance plans
- Employer-paid dental and vision insurance plans
- 13 paid holidays
- Generous paid time off
- 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
- Potential eligibility for loan forgiveness programs, based on position and department, including NHSC, STAR Loan Repayment, Behavioral Health Loan Repayment, and MI Kids Now Loan Repayment
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
