NC Clinical Manager

2 weeks ago

Charlotte, United States Community Alternatives (VA) Full time

The Clinical Manager is responsible for the management and quality assurance of all care management provided throughout all North Carolina program sites as well as the administrative oversight of payer authorizations and utilization management for these services from intake through discharge. This includes ensuring all clinical services authorized and billed are supported by documented medical necessity criteria. The clinical manager shall administer all clinical aspects of client care of the service sites. The Clinical manager will assist in the development of staff trainings and the development of resources to provide best practice and evidence-based treatment to our clientele. The Clinical manager will be responsible for providing in-direct supervision, direction and feedback to all care management staff that provides care management to clients and will be responsible for performance improvement activities. The Clinical manager will participate in activities during and in preparation for all accreditation, licensing, or other surveys/audits.

Internally this position will work directly with supervising care managers, care managers, extenders, designated program staff, the corporate departments.

Externally this position will have routine contact with multiple stakeholders, payers, clients and personnel in the management of care management, authorizations, and other general communication and trouble-shooting.

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*DUTIES AND RESPONSIBILITIES*

The Clinical manager must be a strong, effective and undeterred individual with excellent communication skills who understands the complex needs of people with behavioral health diagnoses and other complex medical issues. This person must be able to work with various community members and care management staff to ensure timely services, reporting and completion of clinical documentation. The position requires a highly organized work style and functional computer skills. The employee must be able to work with a high level of independence and perform duties with a high level of accuracy. The employee must be able to develop, update and enforce compliance with related policy & procedures assuring full regulatory compliance with state license regulations, MCO/Tailored Plan rules and regulations, applicable federal rules, Medicaid, HIPAA and CARF; coordinate Medicaid and state billing with the corporate finance department. Additionally the position is responsible for communicating/participating in program admissions and routine case reviews with multidisciplinary teams and intake staff. The employee is responsible for independent and team chart reviews to ensure medical necessity is clearly documented in consumer medical records.

Proficiency in Microsoft Office Suite is required. Critical data will be collected and entered into spreadsheets and must meet standards of timeliness, accuracy and completeness.

*General Duties*

· Review and analyze the effectiveness of care management

· Oversee the daily submission of service delivery data from staff

· Daily telephonic and email communication with staff and stakeholders

· Routine communication with program staff

· Conduct independent chart reviews checking for documented medical necessity

· Participate in regularly scheduled and ad-hoc staff meetings and clinical reviews

· Participate in periodic care teams as necessary and appropriate both in person and via conference calls/video-conferencing

· Occasional travel to service sites for team building and protocol implementation

· Daily data entry into databases and other designated software programs

· Securing, copying and faxing information as needed ensuring compliance with privacy and confidentiality rules and regulations

· Development of electronic tools and protocols to streamline processes and communication

· Establish protocols to remain current on any and all changes in authorization protocols, changes in billing codes or service rates and related regulatory requirements

· Develop daily, weekly and monthly reports for supervisor and corporate staff

· Engage in regular correspondence with payer in a professional manner

· Observe staff to identify strengths and areas of development

* Assesses cases to determine if the client has reached maximum clinical effectiveness

· Participate in supervision as assigned

· Participate in special projects as assigned

· Perform other duties as assigned

· Ensure that all clinical procedures conform to State, Federal, and CARF Regulations

· Responsible for evaluating the current level of patient care, which may include data collection, entry, and analysis, chart audits and observing direct care management

· Act as a mediator to both clients and employees to help resolve concerns, complaints, and requests, including the submission of timely and accurate reports as required for resolution

· Work closely with all members of team to assure positive working relationships

· Report patient complaints/concerns to respective Vice President or state director and, as per policy, coordinate corrective action

*QUALIFICATIONS*

Completion of at least a Master's degree in a human services field, including social work, psychology, rehabilitation counseling with Licensure in psychology, social work or counseling AND have at least five years of documented experience working directly with individuals who have substance abuse diagnoses. The individual must have at least 5 years of experience in a management position supervising others and 3 years utilization management experience preferred. Proficiency at the intermediate level with Microsoft Office Suite is required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Job Type: Full-time

Pay: From $75,000.00 per year

Benefits:
* Dental insurance
* Health insurance
* Paid time off
* Vision insurance
Medical specialties:
* Addiction Medicine
Schedule:
* Monday to Friday
* Weekends as needed

Education:
* Master's (Preferred)

Experience:
* Substance Abuse: 5 years (Preferred)

License/Certification:
* LCAS (Preferred)

Work Location: In person

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