Deputy Chief of Utilization Management

Position Summary

The Deputy Chief of Utilization Management provides executive-level strategic, clinical, regulatory, and operational leadership for the administration, oversight, and continuous improvement of utilization management (UM) functions within Oakland Community Health Network (OCHN). Reporting directly to the Chief Administrative Officer (CAO), the Deputy Chief is responsible for advancing utilization management strategies that ensure timely, equitable, clinically appropriate, and medically necessary access to publicly funded behavioral health, intellectual and developmental disability, and substance use disorder services.

Essential Duties and Responsibilities

• Provide executive leadership for assigned utilization management functions and develop, implement, and evaluate utilization management strategies aligned with organizational mission, strategic priorities, regulatory obligations, and accreditation expectations.
• Oversee utilization management operations including service authorization, concurrent review, retrospective review, utilization monitoring, and related clinical review processes.
• Ensure utilization management decisions are timely, consistent, clinically appropriate, and supported by established medical necessity criteria and applicable regulatory requirements.
• Serve as the executive operational lead for NCQA utilization management compliance and support CARF accreditation readiness.
• Ensure assigned utilization management operations comply with MDHHS requirements, Medicaid managed care regulations, PIHP contractual obligations, and OCHN policies.
• Collaborate with clinical leadership to promote evidence-based, person-centered utilization management practices and monitor consistency of clinical review decisions.
• Lead the development of utilization management performance dashboards, executive reports, and key performance indicators.
• Collaborate with OCHN's provider network to promote consistent application of utilization management standards and improve coordination of services.
• Support utilization management strategies that balance clinical appropriateness, beneficiary access, service quality, and responsible fiscal stewardship.
• Provide supervision, coaching, mentoring, and performance management for assigned utilization management leaders and staff.

Leadership Competencies

• Strategic Thinking
• Clinical and Operational Judgment
• Regulatory and Accreditation Expertise
• Data-Driven Decision-Making
• Executive Communication
• Change Leadership
• Collaboration and Relationship Management
• Ethical Leadership

Minimum Qualifications

Master's degree in Healthcare Administration, Public Health, Social Work, Nursing, Psychology, Behavioral Health, Business Administration, or a closely related field. An equivalent combination of relevant education and extensive executive-level experience may be considered.

Minimum of seven (7) years of progressively responsible experience in behavioral health, managed care, utilization management, clinical operations, and healthcare administration. Minimum of ten (10) years of management or senior leadership experience with responsibility for operational oversight, staff supervision, program performance, or regulatory compliance.

Preferred Qualifications

• Experience working within Michigan's public behavioral health system, including a PIHP, CMHSP, or Medicaid managed care organization.
• Direct experience preparing for or participating in NCQA accreditation reviews or CARF accreditation surveys.
• Demonstrated success implementing corrective action plans and maintaining accreditation-related documentation.
• Knowledge of MDHHS behavioral health contracts, Medicaid specialty behavioral health benefits, and applicable federal managed care regulations.
• Experience with intellectual and developmental disability services, serious mental illness, serious emotional disturbance, and substance use disorder service systems.
• Professional clinical licensure, such as LMSW, RN, LPC, or psychologist licensure, where relevant to assigned responsibilities.
• Experience leading utilization management departments or large multidisciplinary clinical operations teams.
• Experience implementing utilization management technology, electronic authorization platforms, or business intelligence reporting systems.