Clinician - Local Care Management

Icon Fitness; Battle Creek (MI); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Premium health and vision

Health Reimbursement Account

Disability insurance

401(k) match

YMCA membership

Paid time off

Continuing education reimbursement

Licensure study materials

Trauma-informed System of Care

Job summary

Summit Pointe is seeking a Local Care Manager in Michigan to conduct concurrent utilization reviews, assess clinical documentation, and authorize services based on medical necessity and treatment goals. The role supports policy development, data reporting, and training within a hybrid work setting.

Qualifications include a Master’s in Psychology or Social Work with Michigan licensure, CAADC certification within 90 days, and 2 years in behavioral health care.

Qualifications

• Must have a Master’s degree in Psychology, Social Work or related field and Michigan licensure.
• Two years of behavioral health clinical experience with therapy or testing.
• CAADC Certification required or planned within 90 days of hire.
• CPR and first aid certification preferred.

Responsibilities

• Performs concurrent utilization review for Summit Pointe services.
• Reviews clinical documentation to determine appropriate level of care.
• Makes authorization decisions based on medical necessity and treatment goals.
• Gathers data, prepares reports, and trains staff on utilization review and quality standards.
• Completes continued stay reviews and inpatient retrospective reviews.
• Collaborates with teams to reduce hospital recidivism and improve outcomes.
• Supports KPI tracking and strategy development within the Local Care Management Team.
• Performs other duties as required.

Skills

Trauma-informed care

Crisis intervention

Motivational Interviewing

SBIRT

Assessment & interview methods

Coordination of services

Communication skills

EMR software

CPR/First aid

Education

Master's degree in Psychology or Social Work

Michigan licensure: LMSW/LLMSW or LLP/TLLP or LPC/LLPC

Tools

EMR software

Word/Excel

Job description

Job Summary/Objective:Local Care Management (LCM)/Utilization management (UM) is the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of the applicable health benefits plan, sometimes called “utilization review.”Essential Duties and Functions:Performs concurrent utilization review of Summit Pointe authorized services for individuals diagnosed with intellectual/developmental disability, mental illness and/or substance use disorders.Reviews and assess clinical documentation of the individual served to identify and determine an appropriate level of care based on medical necessity criteria of identified service(s). Clinical documentation includes a review of: Assessment, Individual Plan of Service, progress notes, and other relevant supporting documentation. Including current review of medical necessity to support determination of eligibility.Makes authorization approval or denial determinations based on the individual’s assessed needs, prior utilization patterns of authorized services as applicable, appropriate, and realistic treatment goals, services that are focused on achieving positive outcomes.Reviews and analyzes program utilization data and/or clinical documentation (e.g. customer charts) and evaluates services provided or received to assess compliance with program policies, standards, appropriateness of services and/or medical necessity.Gathers data, prepares reports, and conducts training on utilization review, quality assurance, and standards of care.Identifies the need for and provides feedback on the development/revision of program policy.Completes continued stay reviews for individuals who are in an inpatient setting to determine ongoing medical necessity and authorize additional days of care. Collaborates with internal teams to reduce hospital recidivism.Completes retrospective review of inpatient hospitalizations to determine coverage after treatment has been given. These evaluations occur by confirming member eligibility and the availability of benefits, analyzing customer care data to support the coverage determination process, and receiving supporting clinical documentation from providers with the payment request.The Local Care Manager position is approved for a hybrid work setting, with remote work approved on an individual basis. Employee must be available to be on campus for meetings as needed.Supports the leadership team by fully participating in the Summit Pointe Management System to include maintenance and execution of all assigned key performance indicators as well as annual strategy development and implementation for the Local Care Management Team.Performs other duties as required.Qualifications:Master’s degree in Psychology, Social Work or related field with Licensure in the State of Michigan as a Social Worker (LMSW/LLMSW); Limited Licensed Psychologist (LLP/TLLP); Professional Counselor (LPC/LLPC) mandatory. Full licensure is preferred, limited licensure with minimum 3 years experience.Position requires CAADC Certification but will allow applicants already on the certification development plan or will apply and start CAADC Certification development plan within 90 days from hire.Two years of experience in behavioral health care setting providing clinical services, and/or psychological testing, and psychotherapy or the equivalent utilizing evidence-based practices.Knowledge of psychotherapy, counseling, research methods, crisis intervention techniques, assessment and interview methods, and ability to coordinate programs and services essential.Knowledge of judicial system preferred.One year of computer experience – Word, Excel, and electronic medical record software.Not excluded from participating in Medicaid, Medicare, or any other federal or Michigan health care programs.No criminal history that would preclude employment under federal and state laws and regulations in a federal or state health program.Must support a trauma informed culture of safety to aid customers in their recovery process.CPR and first aid certified.Experience in Evidence Based Practice such as Motivational Interviewing or SBIRT.BenefitsPremium health and vision within 30 days of hireCompany sponsored Health Reimbursement AccountCompany paid short and long-term disabilityEmployee assistance program401(K) match up to 5% after one year of serviceSocial security alternative contributionsFree YMCA membershipGenerous paid time off14 paid holidaysContinuing education reimbursementLicensure study materials and exam reimbursementTrauma Informed System of Care:A trauma-informed approach to service delivery emphasizes physical and emotional safety, choice, empowerment, and trustworthiness for customers. The impact of trauma is broad and touches many life domains. Participation is mandatory for activities required for Summit Pointe to become a “Trauma Informed System of Care.”PCN New