Utilization Review Specialist

This is a fully remote position, open to applicants in Michigan.

📋 Description

• Conduct utilization reviews for services related to intellectual and developmental disabilities, mental health, and intensive treatment services for substance use disorders.

• Evaluate individuals’ existing or proposed treatment plans.

• Recognize and resolve potential obstacles to discharge.

• Aid in the transition of care to suitable intensity service settings.

• Work full-time from Monday to Friday, between 8:00 am and 4:30 pm.

• May occasionally work on weekends or holidays based on the volume of utilization reviews.

• Travel occasionally within the Kent County area and its surroundings.

• Communicate effectively and bridge language/cultural gaps to Network180 services across diverse communities.

• Participate in interviews either in person or online.

⛳️ Requirements

• Fully licensed Master of Social Work (LMSW), fully licensed Marriage and Family Therapist (LMFT), or fully licensed Professional Counselor (LPC); or a limited licensed Psychologist (LLP) with a minimum of five (5) years of clinical experience (preferably two [2] years post-licensure).

• Alternatively, a Registered Nurse (RN) in Michigan with at least two (2) years of clinical experience in providing behavioral health services.

• Proficiency in interpreting clinical summaries and applying established medical necessity criteria for utilization decisions.

• Comprehensive understanding of psychological, emotional, and sociological assessment and diagnosis principles and practices.

• Strong knowledge of professional ethics and standards of practice.

• Capacity to manage multiple projects at the same time.

• Competence in computer applications, including word processing, spreadsheets, email, database management, and data entry.

• Ability to thrive in a fast-paced environment.

• Strong communication skills, both verbal and written, especially in high-stress situations.

• Capability to work effectively in a multicultural setting and bridge language/cultural barriers to Network180 services within diverse communities.

• Successful completion of a drug screening as part of the background check process.

• Adherence to Network180's drug and alcohol-free workplace policy, including the prohibition of recreational marijuana use.

• QIDP certification preferred for roles reviewing intellectual and developmental disability services; requires one year of full-time experience with individuals with developmental disabilities and an appropriate license/degree as per State of Michigan.

• CMHP certification preferred for roles reviewing children's services; requires one year of experience in the examination, evaluation, and treatment of minors and their families, along with an appropriate license/degree as per State of Michigan.

🏝️ Benefits

• Four health insurance plans available.

• 100% employer-paid dental and vision insurance plans.

• 13 paid holidays each year.

• Generous paid time off (PTO).

• Opportunities for professional development.

• Tuition reimbursement programs.

• Reimbursement for professional licenses.

• Defined contribution retirement plan.

• Employee Assistance program.

• Options for life and voluntary life insurance.

• Short-term and long-term disability coverage.

• Approved site for loan forgiveness programs (dependent on position and department), including NHSC, STAR Loan Repayment, Behavioral Health Loan Repayment, MI Kids Now Loan Repayment, and more!

• No weekend, on-call, or holiday commitments for this role.

• Option for remote work arrangements.

• Commitment to equal opportunity employment.

• Provision of reasonable accommodations for individuals with disabilities.