Clinical Care Manager II (Union) - Michigan Licensed

Full-time

Elevance Health

Shift: Sunday through Thursday, from 2:00am - 10:30am. Training will be provided for 5 weeks during regular business hours.
Shift differential:
2nd shift (M-F between the hours of 4:30 pm to 1:00 am) - 5%
3rd shift (M-F between the hours of 1:00 am to 9:30 am) - 10%
Weekend (Shifts in between the hours of 9:30 am Saturday and 1:00 am Monday) -10%
Location: Dearborn, MI
Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.
For associates who are subject to a collective bargaining agreement (CBA): where this guidance is inconsistent with the CBA, the CBA provisions will prevail.
The Clinical Care Manager II provides assessments, referrals, and counseling. Conducts telephone assessments, collecting sufficient clinical information to make appropriate referral and certification decision for emergency/urgent referrals that require alternate levels of care. Makes appropriate certification decisions. Collaborates with providers to determine alternate levels of care and to facilitate transfers to network facilities and providers whenever possible. Facilitates coordination of care with other managers to assure continuity of care. Evaluates clinical appropriateness of treatment using professional knowledge within Carelon Behavioral Health Options clinical and work site guidelines and renders certification decisions or seeks consultations for non-certification decisions. Will facilitate all tracking for necessary quality indicators to meet these necessary accrediting bodies (NCQA, URAC). Directs members to an appropriate therapist or EAP provider and reviews care on a regular basis to determine whether treatment meets Carelon Behavioral Health Options criteria for medical necessity. Refers cases to an MD or Clinical Management staff if unable to determine that medical necessity criteria have been met. Establish and deliver knowledge about care resources and levels of care availability. Special projects and all other duties as assigned.
How you will make an impact:
Primary duties may include, but are not limited to:
1. Coordinate with other Care Managers to assure that patient comprehensive treatment needs are met. Ensure continuity of patient care through contact with providers. Monitor use of, and regulate release of benefits based on medical necessity. Handle provider calls and assess request for approval of release of benefits. Review and monitor cases. Provide follow-up contact and correspondence. Verify benefit coverage to determine that it is active and available in relation to contract terms and annual limits.
2. Complete telephone assessments and referral; gathers demographic and clinical information to connect patient with appropriate provider, including outpatient treatment as necessary; and for emergency, urgent, routine and EAP referrals. Provide appropriate referrals for treatment based in assessment of information gathered during telephone contacts and or on-site with providers. Refer cases that do not meet criteria and need non-cert., to Peer Advisors. Manage release of MHSA benefit provided by carrier for designated group. Ask questions and listen to member in order to assess case and determine needs. Give referral and/or make referral appointment as circumstances warrant.
3. Review for medical appropriateness psychiatric/substance abuse cases utilizing professional knowledge to apply Carelon Behavioral Health Options criteria and render certification Page 2 of 7 decisions that are within the scope of practice that is relevant to the clinical area under review. Provide reviews for predetermination of medical necessity. Review proposed courses of treatment for medical necessity. Utilize rounds and case consultations with Clinical Supervisor and Peer Advisor for cases outside the medical necessity criteria.
4. Interface with internal and external customers to maintain optimal efficiency of service. Maintain telephone superior service standards. Contribute to weekly staff meetings and clinical conferences. Attend appropriate meetings, trainings and conference calls as scheduled. Perform all other aspects of customer service as required. Conduct business in a professional manner. Troubleshoot claims issues. Investigate and research to resolve customer complaint problems and issues.
5. Apply Carelon Behavioral Health Options policies and procedures consistently. Maintain confidentiality of Clients, Business Records and Reports. Maintain ethical and professional standards. Maintain individual productivity and performance standards. Meet Departmental expectations, accuracy, productivity, and performance standards. Support Carelon Behavioral Health Options in achieving its Mission Statement. Complete tasks accurately and within required timeframes. Adhere to the components of the Compliance Program. Ensure that job tasks are performed in a legal and ethical manner. Actively assess work area for non-compliance issues and notify supervisor or call Ethics Hotline. Adhere to compliance training requirements and understand that training is required condition of employment.
Minimum Requirements:
Master's degree in social work, psychology, counseling or a Bachelor's level RN.
Licenses: Current, valid and unrestricted license in the State of Michigan in a mental health field (RN, Ph.D., LCSW/ACSW, LLP, MHC, LPC, etc.).
A minimum of 3 years' experience in psychiatric or substance abuse treatment.
Experience as a CEAP or EAP internal/external consultant to a work site area required (for the integrated unit only), or A minimum of 2 years' experience, prior to licensure with Carelon Behavioral Health Options Clinical Operations Unit functioning as a Clinical Support Specialist with required licensure activities supervised by the Clinical Manager or Clinical Director.
Preferred Qualifications:
Experience in settings that include inpatient, partial, and/or outpatient care preferred.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact View email address on aplitrak.com for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact View email address on aplitrak.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act

Apply

Vacancy posted 13 hours ago

Similar jobs that could be interesting for youBased on the Clinical Care Manager II (Union) - Michigan Licensed in Dearborn, MI vacancy

HVAC Technician II
$34 per hour
...HVAC Technician II Wayne State University is searching for... ...located in the heart of Detroit, Michigan where students from all... ...evaluated and agreed upon by the Management-Union Committee). EPA 608... ...of Detroit Boiler Operators License or City of Detroit Refrigeration...
Union
Hourly pay
Full time
Apprenticeship
Work experience placement
Work at office
Wayne State
Detroit, MI
4 days ago
Behavioral Health Care Manager
...Role Overview: The Care Manager is responsible for managing and coordinating care... ...skills, critical thinking, and clinical knowledge to identify issues, gaps... ...Associate must reside in the state of Michigan (MI) Valid driver's license and car insurance. Must be...
Suggested
Remote work
Flexible hours
AmeriHealth Caritas
Southfield, MI
2 days ago
Echocardiography, Cardiology Electrophysiologist in Roseville & St. Clair Shores, Michigan
...in Roseville and St. Clair Shores, Michigan. \n As part of our team, youll work... ...professionals for seamless care coordination. \n \n \n Clinical Responsibilities \n \n Inpatient... ...Institute \n Shift : Day Job \n Union Code : Not Applicable \n \n...
Union
Full time
Work at office
Shift work
Henry Ford Health
Detroit, MI
14 days ago
Clinical Manager
...behalf of our client for a Clinical Manager. The successful candidate will... ..., ethical, and audit-ready care is provided to a diverse community... ...by Human Resources. Licenses/Certifications: •... ...unrestricted clinical license in Michigan (e.g., LMSW, LPC, LMFT, LP)....
Suggested
Consulting Firm
Dearborn, MI
12 days ago
Anesthesiology, Certified Registered Nurse Anesthetist Dearborn Part Time Days
...pediatrics. Provides airway management services as needed... ...of the health care team to plan and coordinate... ...demonstrates current clinical knowledge in area of... ...\n State of Michigan RN License \n State Specialty... ...Shift: Day Job \n Union Code: Not Applicable...
Union
Part time
Immediate start
Relocation package
Flexible hours
Shift work
Henry Ford Health
Dearborn, MI
18 days ago
Clinical Program Manager
...procedures, professional Code of Ethics, State of Michigan licensing, and COA Council on Accreditation standards; the Clinical Program Manager is responsible for providing leadership,... ...intervention to Housing Specialists and Care Path Navigators in an effort to support...
Vista Maria
Dearborn Heights, MI
16 days ago
Medical Director, Physician - Medical Director, Trauma, Acute and Critical Care - Livoni
...Trauma, Acute & Critical Care Surgery team at Trinity... ...located in Livonia, Michigan. This is an exciting opportunity... ...Info: 304 Beds, Level II Trauma Center \n... ...performance improvement, clinical education, and quality... ...Michigan medical license (or ability to obtain)\...
Full time
Temporary work
Private practice
Flexible hours
Shift work
Trinity Health
Livonia, MI
19 days ago
Mental Health Case Manager
...Social Worker/Mental Health Case Manager to join our team! In this role... ...about providing high-quality care and social services support,... ...must possess a valid driver's license, valid vehicle registration... ...with the consumer and specific clinical staff. Maintain clinical...
Work at office
Flexible hours
National Associations Of Yemeni Americans BHHS
Dearborn, MI
5 days ago
Anesthesiology, Certified Registered Nurse Anesthetist Contingent Columbus
...anesthesiologists and \n other health care providers. \n \n... ...Required and maintains currency of: \n Clinical Privileges \n State of Michigan RN License \n State Specialty Certification... ...Columbus \n Shift: Day Job \n Union Code: Not Applicable \n \n \n...
Union
Flexible hours
Shift work
Henry Ford Health
Detroit, MI
18 days ago
Hospice Patient Care RN Manager
...Overview Advance Hospice Care. Lead Clinical Excellence. Inspire Compassionate Teams. We are seeking a dedicated Patient Care Manager to join our hospice team. Reporting directly... ...Qualifications – What You’ll Bring: Current RN license in the state of employment...
Daily paid
Full time
Part time
Local area
Gentiva Hospice
Southfield, MI
4 days ago
Hospice Patient Care RN Manager
...Overview Advance Hospice Care. Lead Clinical Excellence. Inspire Compassionate Teams. We are seeking a dedicated Patient Care Manager to join our hospice team. Reporting directly... ...Qualifications - What You'll Bring: Current RN license in the state of employment...
Daily paid
Full time
Part time
Local area
Gentiva
Southfield, MI
4 days ago
Anesthesiology, Certified Registered Nurse Anesthetist Full Time Days Rotating Detroit
...join our anesthesia care team. The CRNA... .... Provides airway management services as needed... ...\n ~ Current RN license and CRNA certification... ...\n ~ Excellent clinical judgment,... ...Privileges State of Michigan RN License State Specialty... ...: Rotating \n Union Code: Not...
Union
Full time
Relocation package
Shift work
Rotating shift
Weekend work
Afternoon shift
Henry Ford Health
Detroit, MI
25 days ago
Clinical Manager
...Job Description DETROIT, MI CLINICAL MANAGER JOB DESCRIPTION SSG SCHOOL-BASED MENTAL HEALTH PROGRAM Clinical... ...Institution of higher learning. Independently licensed to practice in the state of Michigan with one of the following licensures/credentials:...
The Stepping Stones Group, LLC
Detroit, MI
2 days ago
Security Police Officer - Armed - 40 hrs/wk - Variable Shift - St. John
...officer within the State of Michigan; ~-OR- A separated... ...Concealed Pistol License. Maintain a valid unexpired... ...requirements listed in II(e). A currently... ...Shift: Variable Union Code: Not Applicable Additional... ...and preventative care to complex and specialty...
Union
Full time
Shift work
Henry Ford Health System
Detroit, MI
5 days ago
Medical Director, Medical Director - Outpatient Direct Clinical
...Medical Director and Clinical Psychiatrist for DWIHNs... ...will perform 80% direct care functions and 20%... ...Provides care compliant with licensing regulations and... ...oversight of proper clinic management and service delivery.... ...n Knowledge of the Michigan Mental Health Code. \n...
Full time
Traineeship
Local area
Weekend work
Detroit Wayne Integrated Health Network
Detroit, MI
a month ago
Trial Attorney
$129.25k - $160k
..., Compliance, and Risk Management Position Type Regular... ...to join the Detroit, Michigan Claim Litigation office... ...requirements including licenses and certifications... ...flexibility you need to take care of you and your family!... ...Farm Federal Credit Union! Take a Little You Time...
Union
Full time
Work at office
Local area
Immediate start
Relocation package
State Farm
Melvindale, MI
2 days ago
Medical Care Coordinator
...across the health plan and care network to ensure members receive... ...risk under supervision of a licensed Care Manager to provide delegated tasks... ...East or Southwest region of Michigan, as HIDE will be implemented... ...work experience in a clinical office or health insurance setting...
Full time
Work experience placement
Work at office
Monday to Friday
Shift work
Corewell Health
Southfield, MI
1 day ago
Anesthesiology, Certified Registered Nurse Anesthetist Wyandotte Full Time Days Rotating
...pediatrics. Provides airway management services as needed... ...of the health care team to plan and coordinate... ...demonstrates current clinical knowledge in area of... ...\n • State of Michigan RN License \n • State Specialty... ...Shift: Rotating \n Union Code: Not Applicable...
Union
Full time
Immediate start
Relocation package
Flexible hours
Rotating shift
Henry Ford Health
Wyandotte, MI
11 days ago
Teller II - Romulus
...join our team! We are looking for a Teller II for our Romulus branch. As a Teller II... ...elevates and celebrates your achievements, cares for your well‑being, and serves with purpose... ...application and submit an up-to-date resume. #J-18808-Ljbffr Public Service Credit Union
Union
Full time
Temporary work
Bank staff
Work at office
Immediate start
Public Service Credit Union
Romulus, MI
4 days ago
Public Safety Officer I
$83.26k - $100.41k
...Hourly, FLSA Non-Exempt - Union DEPARTMENT/... ...the laws of the State of Michigan. Operate motorized public... ...work in the care and upkeep of firefighting... ...successfully attain a Firefighter II Certification. Must... ...Michigan Operator's License and have an acceptable...
Union
Hourly pay
Full time
Flexible hours
City of Oak Park
Oak Park, MI
28 days ago
Branch Manager
...About TRUE TRUE Community Credit Union is a people‑first financial... ...member concerns. Manage branch profitability by monitoring... ...with the Nationwide Mortgage Licensing System & Registry (NMLS). Preferred... ...worships across the State of Michigan. We work hard to create and...
Union
Temporary work
TRUE Community Credit Union
Dearborn, MI
1 day ago
Electrician II Union - 2nd Shift (3:00 PM - 11:00 PM) $42.78/hr. + $0.60/hr. Shift Differential
$42.78 per hour
...Job Description Job Description Electrician II (2nd Shift, M-F, 3:00pm - 11:00pm) Hourly Wage Rate $42.78 + shift premium... ...Journeyman card is $42.78. Reporting to the Purchasing and Maintenance Manager, this person will be responsible to install, maintain, and...
Union
Hourly pay
Temporary work
Local area
Shift work
Afternoon shift
Unistrut International Corporation
Wayne, MI
10 days ago
Auto MechanicTechnician I (Union)
...repairs and maintenance which may include: OBD II systems, brake components, tires, tune-... ...duties as assigned by supervisor or manager. Who You Are You're a quick learner... ...~ Safe drivers needed; valid driver's license required SMCOX Applicants must...
Union
Work experience placement
Cox Automotive
Inkster, MI
3 days ago
Lab Pack Chemist II
...recruiting and hiring for this role is being managed in partnership with the Clean Earth... ...procedures. • Maintain a Commercial Driver’s License (CDL) with Hazmat Endorsement to legally... ...benefits for employees represented by a union are outlined in their collective...
Union
Contract work
Local area
Night shift
Veolia
Detroit, MI
5 days ago
UPS - Package Delivery Driver $45+/hr
$45 per hour
...Transportation (DOT) physical exam and maintaining a valid driver’s license with a clean driving record in accordance with UPS and DOT... ...1(k), paid vacation, paid holidays, overtime opportunities, and union-negotiated wage increases. UPS drivers may also receive overtime...
Union
Hourly pay
Full time
UPS
Inkster, MI
1 day ago
Commercial Journeyman Electrician or Three-Year Apprentice Non Union
...spaces, offices, and property management facilities. Read Prints:... ...strict compliance with the Michigan Electrical Code and current... ...Requirements & Qualifications License: Preferred valid State of... ...across Metro Detroit. As a non-union shop, we pride ourselves on a...
Union
Hourly pay
Apprenticeship
Local area
Night shift
Clear Water Pool & Spa, Inc.
Livonia, MI
15 days ago
Hematology/Oncology Clinical Trials | Nurse Practitioner / Physician Assistant | Henry Ford Health
...will have Saturday clinic hours. No call. Hematology... ...in cancer care. Engage in a team-oriented... ...and illnesses Manage bloodborne pathogen... ...accredited program Current Michigan licensure National... ...Substance License (CSL) required through... ...Shift: Day Job Union Code: Not Applicable...
Union
Full time
Monday to Friday
Shift work
Weekend work
Henry Ford Health
Detroit, MI
5 days ago
Clinical Manager RN
$80k - $110k
...personalizing and coordinating care. Do you love helping... ...state of being possible. The Clinical Manager is a Registered Nurse (RN)... ...of nursing and is currently licensed to practice in the state where... ...nurse in the state of Michigan, two years experience as a RN...
Flexible hours
Boost Home Health
Southfield, MI
2 days ago
Operations Health Manager
...direction from a senior level manager, the Operations Health... ...May provide direct care to patients as needed... ...health setting as a Fully Licensed Master Social Worker,... ...capacity in a clinical setting Experience with... ...Clinical Supervisor - Michigan (CCS-M) may be required...
Work at office
Local area
Arab Community Center for Economic and Social Services
Dearborn, MI
1 day ago
Teller
...Teller At LOC Credit Union, we believe in helping our members achieve their financial dreams through our "Let's Win. Together."... ...lasting relationships. We're a trusted part of the Southeastern Michigan community, focused on making banking simple and satisfying....
Union
Full time
LOC Credit Union
Dearborn, MI
1 day ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Clinical Care Manager II (Union) - Michigan Licensed. Be the first to apply!