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Utilization Care Manager Jobs in Michigan (NOW HIRING)

Trinity Health

Care Manager I

Ann Arbor, MI · On-site

The Care Manager I is an integral member of the office care team. Provides care management and care ... utilization and monitoring of health care resources, and assumes a collaborative role with all ...

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Utilization Care Manager information

How does a utilization care manager collaborate with medical and administrative teams to ensure effective patient care?

Utilization Care Managers work closely with physicians, nursing staff, and administrative teams to review patient cases, determine medical necessity, and coordinate appropriate care plans. They frequently participate in interdisciplinary meetings, communicate with insurance providers regarding authorizations, and ensure compliance with regulatory guidelines. This collaborative approach helps to optimize resource utilization, improve patient outcomes, and support smooth transitions of care. Being proactive in communication and documentation is key to success in this role.

What is a utilization care manager?

Utilization Care Managers are healthcare professionals responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They work to ensure that patients receive the right care at the right time, while also helping healthcare organizations manage costs and comply with regulations. Utilization Care Managers often review patient cases, coordinate with medical staff, and interact with insurance companies to authorize or deny services. Their goal is to optimize healthcare delivery, reduce unnecessary procedures, and improve patient outcomes.

What are the key skills and qualifications needed to thrive as a utilization care manager, and why are they important?

To thrive as a Utilization Care Manager, you need a background in healthcare, typically as a registered nurse or social worker, with expertise in care coordination and utilization review. Familiarity with utilization management software, medical necessity guidelines (such as Milliman or InterQual), and knowledge of insurance regulations are important. Strong analytical thinking, attention to detail, and effective communication skills help you advocate for patients while working with healthcare teams and payers. These skills ensure appropriate resource use, quality patient outcomes, and compliance with regulatory standards.

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

AspectUtilization Care ManagerUtilization Review Nurse
CredentialsRN, case management certificationRN, certification in utilization review
Work EnvironmentHealthcare facilities, insurance companiesHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing resourcesReviewing medical necessity, approving treatments

Utilization Care Managers focus on coordinating patient care and managing resources, while Utilization Review Nurses primarily evaluate medical necessity for treatments. Both roles require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

What are popular job titles related to Utilization Care Manager jobs in Michigan? For Utilization Care Manager jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Utilization Care Manager jobs in Michigan look for? The top searched job categories for Utilization Care Manager jobs in Michigan are:
What cities in Michigan are hiring for Utilization Care Manager jobs? Cities in Michigan with the most Utilization Care Manager job openings:
Utilization Care Manager jobs near you

Care Manager

Northpointe Behavioral Healthcare System

Kingsford, MI • On-site

$49K - $68K/yr

Full-time

Re-posted 17 days ago

Job description

Description

Northpointe is a Community Mental Health (CMH) organization providing services to individuals with serious mental illness, emotional disturbance, substance abuse disorders, and intellectual/developmental disabilities across Iron, Dickinson, and Menominee counties in the UP of Michigan. Northpointe itself was established in 1995 but has roots as a CMH dating back to 1964. Our presence can be found through remote emergency services, in school and home-based programs, and in clinical and residential home settings.


Job Purpose

We are looking for a passionate, driven individual to join our team as a Behavioral Health Care Manager to work at our Dickinson County location. This role assists individuals with intellectual/developmental disabilities and/or serious mental illness through linking and coordinating to services and support systems. The goal of the Care Manager is to help individuals achieve maximum independence through person-centered planning by developing natural supports, obtaining medically necessary services, connecting to community resources, and to establish the foundation to recovery.


Job Duties and Responsibilities

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by the supervisor.


Essential Duties

  • Coordinates an ongoing assessment process to identify individual's strengths, abilities, disabilities, and needs based upon the utilization of diagnostic, evaluative, and progress reports.
  • Assists the individual in achieving maximum independence with medications and adherence to prescribed medications.
  • Utilizes person-centered planning practices in delivery of services to individuals.
  • Develops an individual plan of service with provision for linkages to other services based on the needs of the individual including residential, day program, rehabilitative services, DHHS, Social Security, etc.
  • Facilitates all treatment team meetings and assumes the final responsibility for organization and implementation of the individual plan of service.
  • Provides an ongoing process of treatment monitoring of services being delivered to an individual, assessing whether they are adequate for the needs of the individual and plan of service. This includes assessment of clinical outcome and individual satisfaction.
  • Links individual and individual's family to other community resources.
  • Conducts case transfers and case terminations in accordance with Northpointe policy and procedure.
  • Complies with the policies/procedures of the agency, licensing requirements, and the Medicaid Provider Manual.
  • Prepares for the Behavior Management Committee and participates in the committee as needed on a case-by-case basis.
  • Provides educational services to individuals, family members, guardians, and staff about intellectual/developmental disabilities, mental illness, specific treatment issues and recovery.
  • Provides advocacy for the individual to ensure needs are addressed and rights are protected.
  • Develops an individual safety plan of service with provision for linkages to other services based on the needs of the individual.
  • Completes and maintains accurate, timely required documentation per Northpointe's documentation policies/procedures as verified through electronic monitoring; chart audits and applicable ELMER reports (unsigned documents, progress note timeliness, late IPOS, etc.). Completes documentation tasks electronically whenever possible (ex: capturing electronic signatures, etc.).

Requirements

This position will actively support the mission, vision, and values of the agency.


Education, Certifications, and/or Experience

  • Bachelor's degree in social work (BSW), registered nurse, or bachelor's degree in a human services area
  • Michigan license requirements
  • Limited Licensed Bachelor's Social Worker or Licensed Bachelor's Social Worker (Social Workers must obtain full licensure (i.e., LBSW) within 6 months of being eligible for such licensure)
  • Licensed Registered Nurse
  • Registered Social Services Technician (for Bachelor's in Human Services degrees)
  • Experience working with individuals with a developmental/intellectual disability and/or mental illness preferred.

* Fully Licensed eligible for a higher pay scale than shown below.

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