Clinical Care Management Specialist FOCUS
3 weeks ago
The CCM Specialist will also be responsible for utilization management by conducting utilization review activities, population management, cross-system consultation, and treatment quality monitoring. As a member of the Children’s Complex Care team, you will have an opportunity to apply your understanding of behavioral health and your cultural competence to work collaboratively with CBH members, their caregivers, their supports, other professionals, and community partners to screen/assess, and develop individualized, family-anchored, comprehensive, and strength-based plans of care. The CCM Specialist must utilize clinical knowledge of best practices and evidence-based treatments to ensure CBH members receive timely access to quality, medically necessary behavioral health services. When clinically indicated, Clinical Care Managers consult with CBH Physician and Psychologist Advisors to ensure the most effective treatment for the CBH member is being authorized.
*This position is a hybrid role with an expectation to go into the members’ homes as well as on sites in Philadelphia area; with two days in the office at 801 Market Street.
Essential Functions:
- Work directly with members, natural supports and providers in the community, including in members’ homes.
- Facilitate care coordination. Using an inter-generational approach, with system partners to address social determinants, barriers to wellness, and other needs of members, including connection to appropriate community-based services.
- Facilitate family Plan of Care meetings for assigned members monthly.
- Be knowledgeable about behavioral health care services, system partners, service continuum and established medical necessity criteria and apply that knowledge in all work activities.
- Complete Utilization Management activities including but not limited to: interagency meetings, social determinants interviews with members, treatment team meetings, case consultations, care coordination, provider meetings, reviews, treatment linkage, within established timeframes.
- Authorize treatment when Medical Necessity Criteria is met.
- Consult with Physician Advisor, Psychologist Advisor and/or Clinical Leadership as clinically appropriate.
- Generate denial letters based on physician reviews and in accordance with state regulations as needed.
- Demonstrate an understanding of Evidence-Based Practices (EBPs) and connect members to appropriate evidence-based treatment
- Collaborate with other CBH departments to ensure quality of care, promote placement of members in the most appropriate services and to facilitate consistent longitudinal care management.
- Document provider quality concerns in accordance with CBH policy/procedure.
- Use data to inform clinical decision-making
- Maintain documentation in CBH’s electronic system consistent with agency and industry standards.
- Respond to care coordination correspondence within 24-48 hours or sooner if necessary.
- Attend all meetings as assigned and actively prepare for and participate in supervision and clinical case consultations
- Ensure highest quality of customer service when interacting with members, providers, and other stakeholders.
- Display commitment to member and family driven care and principles of resiliency and recovery.
- Contribute to projects and other duties as assigned.
Team Specific Responsibilities:
- Facilitate monthly Plan of Care meetings for the families of each assigned member monthly.
- Provide evidence-informed intermediate care management interventions directly to members in the community.
- Maintain a care management caseload of approximately 18 members (or as otherwise directed).
- Facilitate care coordination with external entities including behavioral and physical health providers, Child Welfare, Juvenile Justice, School district of Philadelphia, and Targeted Case Management (TCM), as well as any other providers or systems involved with assigned members’ families.
- Address member/caregiver engagement in treatment by reporting or addressing any reported/observed quality concerns, resolving communication barriers between member (and/or caregiver) and providers, assisting member/caregiver with mediation issues/barriers, assisting with any clarification/prioritizing issues, increase positive collaboration with providers and other supports.
- Facilitate longitudinal care management of all assigned members.
- Complete UM activities as assigned and within required timeframe
Position Requirements:
- Education: Master’s degree in Social Work or related field
- Clinical Licensure: Qualified candidates are required to obtain license within first 18 months (1.5 years) of employment; PA Child Abuse Clearance required.
- Required Licensure: Licensed Social Worker (LSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW)
- Relevant Work Experience: Minimum of 3 years of direct clinical care experience working with adults, children, adolescents and/or their families in behavioral health settings and experience in assessment and treatment planning; and/or experience in a managed care setting
Skills:
- Excellent clinical case conceptualization skills
- Meeting facilitation
- Proactive planning
- Customer service
- Familiar with medications
- Excellent verbal and written communication skills and ability to use them when communicating with internal and external stakeholders.
- Excellent interpersonal and collaboration skills
- Conflict and crisis management
- Reliable, accountable, resourceful, curious, flexible and creative
- Empathetic (Accepting/non-judgmental)
- Proficient in MS Office, especially with Excel, and able to type at least 40 words per minute
- Ability to work independently and as part of a team
- Excellent time management and prioritization skills and ability to multi-task
- Compliant with HIPAA regulations
Work Conditions (including travel, overtime required, physical requirements and occupational exposure):
- Must be able to regularly travel within Philadelphia and surrounding counties.
- Regularly requires walking, standing, stooping, bending, sitting, reaching, pushing, pulling and/or repetitive wrist/hand movements for various lengths of time throughout the day.
- Ability to utilize computers and office equipment to complete daily work responsibilities.
- Regularly works inside in areas that are adequately lighted and ventilated. Some fluctuation in temperature. No protective equipment routinely needed.
- Must be able to adapt to continuous changes/demands of the job.
U.S. Authorization Requirement:
- CBH does not provide sponsorship for ap
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