Utilization and Quality Improvement Manager

Utilization and Quality Improvement Manager

The Utilization and Quality Improvement Manager leads and manages programs focused on utilization and quality improvement. This leadership position is responsible for supervising and coordinating staff to ensure individuals served receive services that are efficient, cost-effective, and aligned with quality standards, medical necessity, and person-centered planning.

Key Responsibilities:

• Leadership and Supervision
• Supervise and direct Utilization and Quality Improvement staff, ensuring high performance and adherence to standards.
• Utilization Review
• Assist and guide clinical staff in understanding and determining clinical Medical Necessity for specific services.
• Conduct reviews of service delivery for efficient, cost-effectiveness, and compliance with medical necessity.
• Approve or deny service authorization requests, ensuring proper feedback, and documentation.
• Compliance and Accreditation
• Oversee liaison with accreditation bodies (CARF, MDHHS, MIFAST, etc.), helping to ensure full compliance with standards.
• Supervise Quality staff responsible for monitoring and reporting on program outcomes and quality metrics.
• Provide leadership and direction to incorporate required standards and best practices within Pathways' clinical programs.
• Training and Development
• Provide training to clinical staff on tools, documentation standards, and person-centered planning.
• Mentor and support staff in achieving clinical excellence.

Qualifications:

• Education: Master's degree in relevant field (required).
• Licensure: Licensed Master of Social Work (MSW / LMSW) or Limited Licensed Psychologist (LLP) with 2 years of experience or Licensed Professional Counselor (LPC) or Limited Licensed Masters of Social Work (LLMSW) would be considered for strong candidate.
• Experience: Preferred experience working with individuals with developmental disabilities or mental illness.
• Other Requirements: Valid Driver's License.

Schedule: Monday to Friday, Day shift