Local Care Management Lead

Icon Fitness; Battle Creek (MI); On-site; USD 85,000 - 105,000; Full time

Job summary

Summit Pointe seeks a Local Care Management Lead to supervise the LCM Team and oversee utilization management activities supporting medically necessary, person-centered behavioral health services in Battle Creek, Michigan.

You will collaborate with clinical, operational, quality, and provider network teams to align with MDHHS and CMH expectations, and promote continuous quality improvement organization-wide.

Qualifications

• Master's degree in a behavioral health field.
• Current Michigan clinical licensure.
• 3+ years in behavioral health with utilization management or quality activities.

Responsibilities

• Supervise local care management team operations and workflows.
• Oversee utilization reviews to ensure medical necessity and standards.
• Monitor authorization practices and service levels for compliance.
• Provide coaching on policies, criteria, and documentation.
• Lead quality improvement initiatives and audits.

Skills

Leadership

Utilization management

Clinical supervision

Quality improvement

Project leadership

Education

Master's degree in Social Work / psychology / counseling

Michigan clinical licensure

Tools

EMR systems

Microsoft Office

Job description

# Local Care Management Lead175 College St, Battle Creek, MI 49037-3432, United StatesFull Time**Job Summary/Objective:**The Local Care Management Lead is responsible for managing the Local Care Management (LCM) Team and overseeing utilization management activities that support the delivery of medically necessary, person-centered behavioral health services. The LCM Team is dedicated to ensuring consistent application of medical necessity criteria, authorization standards, and local standards of care while promoting high-quality outcomes for individuals receiving services.This position works collaboratively with clinical, operational, quality, and provider network teams to ensure utilization management processes are consistent with Michigan Medicaid requirements, CCBHC standards, Community Mental Health (CMH) expectations, and organizational policies. The Local Care Management Lead will work with the Director of Clinical Quality to support organizational values, strategic initiatives, regulatory compliance, and continuous quality improvement.**Essential Duties and Functions:*** Supervises and supports the daily operations of the Local Care Management Team, ensuring timely and consistent utilization management activities.* Oversees concurrent, retrospective, and prospective utilization reviews to ensure services meet established medical necessity criteria and local standards of care.* Monitors authorization practices, service utilization, and level of care determinations to ensure consistency, regulatory compliance, and equitable decision making.* Provides consultation, coaching, and education to clinical staff regarding medical necessity criteria, utilization management processes, documentation expectations, and local standards of care.* Reviews utilization trends, authorization data, and quality metrics to identify opportunities for improvement and reduce variation in clinical decision-making.* Leads audits of utilization management processes and documentation, develops corrective action plans, and monitors implementation of identified improvements.* Collaborates with Clinical Quality, Quality Assurance, Provider Network, Finance, and Program Leadership to support coordinated quality improvement initiatives.* Maintains and updates local utilization management procedures, standards of care, and related policies to ensure alignment with MDHHS, CCBHC, and managed care requirements.* Prepares and presents utilization management reports, performance measures, and quality indicators to organizational leadership.* Acts as a member of the Summit Pointe Management System team by managing assigned key performance indicators, supporting annual strategy development, and leading continuous improvement initiatives for the Local Care Management department.* Maintains confidentiality and privacy in accordance with HIPAA, 42 CFR Part 2, MDHHS, and all applicable state and federal regulations.* Performs other duties as required.**Qualifications:*** Master's degree in Social Work, Psychology, Counseling, or another behavioral health-related field.* Current Michigan clinical licensure.* Minimum of three years of behavioral health clinical experience, including experience with utilization management, care management, or clinical quality activities.* Previous supervisory, team lead, or project leadership experience preferred.* Demonstrated knowledge of medical necessity criteria, utilization management principles, behavioral health standards of care, and person-centered planning.* Knowledge of Michigan Medicaid, Community Mental Health (CMH), CCBHC, and regulatory requirements.* Experience analyzing utilization, quality, or performance data to support continuous improvement initiatives.* Strong organizational, communication, problem-solving, and leadership skills with proficiency in electronic medical record systems and Microsoft Office applications.* Experience with quality improvement methodologies, audit processes, or regulatory review activities preferred.**Trauma 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 NEWBased on the job description, briefly explain how your education and experience qualifies you for this position. is required.### EducationRich Text Editor, xApplicant-In\_addition\_to\_current\_or\_most\_recent\_employer\_\_please\_list\_all\_previous\_employers\_in\_the\_past\_10\_years\_\_Please\_list\_newest\_Editor toolbarsFontSizeFormatPress ALT 0 for help|In addition to current or most recent employer, please list all previous employers in the past 10 years. Please list newest to oldest employers. Please include: From / To Date, Company Name / Job Title, Brief Description of Duties, Supervisor's Name, Supervisor's Contact Number and Email Address, Reason for Leaving is required.Rich Text Editor, xApplicant-If\_convicted\_of\_a\_crime\_\_please\_list\_date\_\_location\_\_city\_and\_state\_\_\_name\_at\_time\_of\_conviction\_and\_describe\_final\_dispositEditor toolbarsFontSizeFormatPress ALT 0 for help|Summit Pointe provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.**APPLICANT ACKNOWLEDGEMENT AND ATTESTATION (Please read before signing)**I certify that answers given herein are true and complete to the best of my knowledge.I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I authorize all present or former employers and all persons listed by me as a reference to supply all requested information & documentation to Summit Pointe. I release my present & former employers from all liability for any damage on account of furnishing such information.When contacting references (both professional references and present & former employers) Summit Pointe may ask questions including, but not limited to, attendance, cooperation, initiative, quality of work, job knowledge, strengths and weaknesses. I hereby give Summit Pointe permission to contact any references listed on this application, and my former/present employers that are not listed on this application.This application for employment shall be considered active for a period of time not to exceed 3 months. Completing this application will in no way assure I will be employed.In the event of employment, I understand that false, misleading or incomplete information given in my application or interview(s) will result in discharge. As a condition of employment I will be required to authorize background checks and submit a drug/alcohol screen. I understand, also, that I will be required to abide by all policies and procedures of the employer. Also, an offer of employment should in no way be construed as a contract of continued employment.Summit Pointe provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.Applicants have rights under Federal and State Employment Laws. Please click on the links below to view:A complete set of Employment Posters is posted outside of the Summit Pointe Human