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Local Care Management Lead 3.2 3.2 out of 5 stars 175 College St, Battle Creek, MI 49037 Full-time Summit Pointe 35 reviews

Full-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 NEW About Us 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: Family and Medical Leave Act (FMLA) Know Your Rights Poster Employee Polygraph Protection Act (EPPA) A complete set of Employment Posters is posted outside of the Summit Pointe Human Resources Office located at 175 College St. Battle Creek, MI 49037-3432. Join the Pointe! Join Summit Pointe and join an amazing organization that makes a difference every day in Southwest Michigan! We are looking for additional team members to be part of our team! In addition to joining a dedicated, passionate group of people, our employees enjoy the following perks: Competitive salary Premium health, dental and vision benefits within 30 days of hire Deductible and co-insurance reimbursement program Short term disability, long term disability and company paid Employee Assistance Program 401(k) match after one year of service Social Security alternative contributions Free YMCA membership Generous paid time off policy Ten paid holidays Employee appreciation events throughout the year Annual performance reviews and opportunities for advancement Continuing education reimbursement Licensure study materials AND licensure exam reimbursement Summit Pointe participates in E-Verify - please click on the links below for more information related to the E-Verify Process. E-Verify Participation Right to Work Employment Poster We appreciate your interest in employment with Summit Pointe and we look forward to reviewing your completed employment application and resume. Explore Company Location www.summitpointe.org/ 175 College St, Battle Creek, MI 49037-3432, United States US +1 2699661460