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Manager Utilization Management Jobs in Michigan (NOW HIRING)

UHS

Utilization Review Manager

Grand Rapids, MI

The Utilization Manager is responsible for directing and overseeing the Utilization Program for ... This includes the implementation of case management scenarios, consulting with all services to ...

UHS

Utilization Review Manager

Grand Rapids, MI

The Utilization Manager is responsible for directing and overseeing the Utilization Program for ... This includes the implementation of case management scenarios, consulting with all services to ...

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

The Utilization Manager is responsible for directing and overseeing the Utilization Program for ... This includes the implementation of case management scenarios, consulting with all services to ...

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Manager Utilization Management information

What are the key skills and qualifications needed to thrive as a Manager Utilization Management, and why are they important?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

What is the difference between Manager Utilization Management vs Utilization Review Nurse?

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

What are some common challenges faced by a Manager in Utilization Management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What does a Manager of Utilization Management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.
What are the most commonly searched types of Utilization Management jobs in Michigan? The most popular types of Utilization Management jobs in Michigan are:
What are popular job titles related to Manager Utilization Management jobs in Michigan? For Manager Utilization Management jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Manager Utilization Management jobs in Michigan look for? The top searched job categories for Manager Utilization Management jobs in Michigan are:
What cities in Michigan are hiring for Manager Utilization Management jobs? Cities in Michigan with the most Manager Utilization Management job openings:
Manager Utilization Management jobs near you
Utilization Management Manager

Utilization Management Manager

Region 10 PIHP

Port Huron, MI

Full-time

Medical, PTO

Posted 7 hours ago

Job description

$3,000 Sign on Bonus Available!

Overview: Region 10 is committed to being a premier employer by enhancing the lives of our team and supporting their growth as people and professionals. Sign on bonus of $3,000 available. We provide competitive wage scales that reward experience and performance, ongoing career development and training opportunities, excellent health coverage, generous paid time off with additional performance-based incentives, 13 paid holidays, flexible scheduling, and a comprehensive benefit program.

Essential Functions

The UM Manager position is an administrative position with responsibility in providing direction for clinical service delivery of behavioral health services across the region respective to the Utilization Management Plan, regional clinical practice guidelines, Medicaid Provider Manual and MDHHS contract requirements.

An employee at this level will be involved in the following duties, which do not include all tasks to be performed:

  • Member of Region 10 Utilization Management Committee
  • Assists with implementing regional Utilization Management Program Plan
  • Assists with the development and generation of strategies, functions, and UM/UR monitoring/evaluation reports supporting UM Program Plan Redesign implementation
  • Directs regional Utilization Review across the CMH and SUD provider networks, including case finding, review protocol updates, and quarterly and end of year reports.
  • Serves as member on Region 10 Improving Practices Leadership Team, Region 10 Credentialing and Privilegiing Committee, and other work groups as required.
  • Assists in the development and periodic evaluation of regional clinical practice guidelines
  • Facilitates and supports provider network implementation and sustainment activities pertaining to MDHHS evidence-based practices and practice standards and guidance documents
  • Provides technical guidance in clinical issues related to regional Credentialing and Privileging policy standards
  • Provides technical guidance in clinical issues related to regional Grievance and Appeal policy standards
  • Reviews UMC quarterly reports from CMHs (Behavioral Treatment Plan services, emergency use of physical management, Adverse Benefit Determination, Customer Involvement, Wellness / Healthy Communities)
  • Provides periodic reports to the Region 10 PIHP Sentinel Events Review Committee (Critical Incidents, Sentinel Events, Risk Events Management)
  • Serves as backup to the CCO on the state-wide UM Directors Group

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