$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

Salary : $61,200