Clinical Care Manager II (Union) - Michigan Licensed

Clinical Care Manager II (Union) – Michigan Shift: Sunday through Thursday, 2:00am–10:30am. Training: 5weeks during regular business hours. Shift differential: 2nd shift (M‑F, 4:30pm–1:00am) –5%; 3rd shift (M‑F, 1:00am–9:30am) –10%; Weekend (Shifts 9:30am Saturday–1:00am 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. Responsibilities Conduct telephone assessments and gather clinical information to determine referrals and certification decisions for emergency, urgent, and routine cases. Make certification decisions, collaborate with providers and other managers to facilitate transfers, and coordinate care to ensure continuity. Evaluate clinical appropriateness of treatment using Carelon Behavioral Health Options guidelines, render certification decisions or seek consultations, and track quality indicators for accrediting bodies (NCQA, URAC). Direct members to an appropriate therapist or EAP provider, review care to ensure it meets criteria for medical necessity, and refer to MD or Clinical Management staff if necessary. Maintain knowledge of care resources and levels of care availability, and perform special projects and other duties as assigned. Coordinate with other Care Managers to assure comprehensive treatment needs are met, monitor benefit usage, handle provider calls, verify benefit coverage, and provide follow‑up contact and correspondence. Review psychiatric and substance abuse cases for medical appropriateness, utilize rounds and case consultations with Supervision and Peer Advisors, and review proposed courses of treatment for medical necessity. Interface with internal and external customers to maintain service standards, attend weekly staff meetings and clinical conferences, troubleshoot claims issues, and investigate customer complaints. Apply Carelon policies and procedures consistently, maintain confidentiality, ethical standards, productivity, and performance, and support the compliance program. Qualifications Minimum educational requirements: Master’s degree in social work, psychology, counseling OR a Bachelor’s degree with RN licensure. Licenses: Current, valid, and unrestricted mental‑health license in the State of Michigan (RN, Ph.D., LCSW/ACSW, LLP, MHC, LPC, etc.). At least 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, or at least 2 years of prior experience, prior to licensure, functioning as a Clinical Support Specialist with supervision by a Clinical Manager or Clinical Director. Preferred: Experience in inpatient, partial, and/or outpatient care settings. 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. #J-18808-Ljbffr