LifeWays Community Mental Health
  • 27-Jun-2019 (EST)
  • Utilization Management
  • Jackson, MI, USA
  • Professional III
  • Full Time

12 Paid Holiday's, Free Dental and Vision Insurance, Paid Time Off, Pension, Medical Insurance


Under the direction of the Utilization Management Supervisor, the Utilization Manager authorizes and monitors mental health services based on eligibility and medical necessity criteria for Medicaid and indigent populations in Jackson and Hillsdale Counties. 

Essential Functions:

  • Exercises independent judgment and decision making in determining the on-going eligibility of consumers for public mental health services and supports.
  • Authorizes mental health services for children and adults within the Network based on medical necessity criteria.
  • Completes utilization reviews (prospective, concurrent, targeted and retrospective) to manage the care of assigned populations using available data.
  • Participates in the Clinical Record Review process.
  • Meet Key Performance Indicators for job assignments as determined by LifeWays Leadership.
  • Serve as a member of the clinical bench (back-up coverage when Clinical Division staff are not available to handle consumer needs), completing essential Access functions (Screens, Intakes, Crisis calls, and Crisis Interventions) as needed and as credentialed by LifeWays.
  • Authorize mental health services for other populations (child/inpatient/etc.) as needed to provide for coverage of utilization review within appropriate timelines.
  • Assist the Omnibus Budget Reconciliation Act of 1987 (OBRA) coordinator by making independent clinical decisions in authorizing Pre-Admission Screening (PAS) or Annual Resident Review (ARR), manage calls from nursing homes, hospitals, providers and MDHHS, as assigned. Enters data into OBRA data base, write evaluations, make final recommendations, type letters, copy evaluations and mail out to numerous destinations. Files completed evaluations and completes monthly billing to MDHHS as needed.
  • Conducts site visits to crisis homes, residential facilities and LifeWays provider sites to complete utilization or clinical record reviews, assist in problem solving with service issues, facilitate discharge planning as necessary. These meetings generally occur in Jackson and Hillsdale counties, but travel within the State of Michigan may be necessary.
  • Assist with training for and monitoring of Person Centered Planning activities within the LifeWays network.
  • Responsible for adherence to all Commission on Accreditation of Rehabilitation Facilities (CARF) and Michigan Department of Health and Human Services (MDHHS) standards.

Education/Certification/Licensure:

  • Master's degree in human service field or Bachelor in Nursing, required.
  • Appropriate licensure with the State of Michigan, required.
  • Credentialing requirements for ongoing clinical privileges with LifeWays, required.
  • CPI Non-violent Crisis Intervention training, upon hire.
  • Must have reliable transportation*

 

*LifeWays vehicles are provided to employees for the purpose of transporting consumers; employees must possess a valid MI motor vehicle operator's license and verification of an acceptable driving record.  Personal vehicles may be used for company business when drivers meet the following; valid MI motor vehicle operator's license and proof of personal vehicle insurance in accordance to guideline.

LifeWays Community Mental Health
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