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Clinical Care Management Coordinator

3 months ago

Philadelphia, United States Community Behavioral Health Full time

The Clinical Care Management Coordinator: Psychiatric Emergency Services is responsible for directing the daily operations related to their respective clinical teams to ensure the standards of care and practices are being delivered in accordance with state regulation guidelines.
Core Expectations:

Community Behavioral Health (CBH) will hold each employee accountable for the following expectations which align with our mission, vision, and corporate code of conduct.

  • Perform key responsibilities as detailed in this job description in a dependable, responsible, and positive manner, consistent with all state and federal guidelines.
  • Serve as a role model by exemplifying professional behavior, language, skills, and attire in order to promptly and accurately serve the needs of stakeholders, members and their families.
  • Assure adherence to CBH policies and procedures so that all work is of the highest quality and delivered in the most culturally competent and cost effective manner.
  • Promote and manage diversity and acceptance within CBH and with all members and stakeholders by honoring and respecting their individuality, dignity and rights.
  • Offer suggestions and develop solutions to help promote effective and efficient work processes and innovative programs.
  • Actively participate in required meetings and complete all mandatory trainings.
  • Maintain high levels of advocacy and member confidentiality to ensure the success of CBH and our mission.
  • Assist in assuring both internal and external program integrity by being alert to and reporting suspected instances of provider and employee fraud, waste or abuse.
Essential Functions:
  • Builds and maintains a strong functional team through effective recruiting, training, performance management, coaching, team building and succession planning.
  • Creates policy and protocols to help the Clinical Department function effectively.
  • Performs and oversees clinical quality auditing and feedback.
  • Monitors productivity and ensure that standards are being met.
  • Provides regular supervision and documentation of supervision consistent with standards in the field.
  • Participates in internal and external meetings to develop, monitor and analyze services and resources to ensure these effectively and efficiently meet the needs of members.
  • Ensures that Clinical Care Managers have ease of access to provider sites to conduct work with members, families and providers.
  • Accompanies Clinical Care Managers and Clinical Supervisors to community between 10 and 15% of work time to provide ongoing clinical supervision and feedback.
  • Meets with staff to provide clinical consultation on cases.
  • Works with Physician Advisors to ensure appropriate consultation for high risk members.
  • Anticipates and manages response of crisis situations.
  • Works closely with Clinical Care Management Coordinators of other teams to facilitate consistent longitudinal care management.
  • Works collaboratively with the Quality Management Department to identify key indicators of provider stability and ensures monitoring and action to rectify any concerns.
  • Maintains collaboration with other CBH departments to ensure intradepartmental efficiencies.
  • Ensures interdisciplinary communication of critical member and provider related information.
  • Obtains and reviews data relevant to members served by the team, clinical operations and staff monitoring to guide interventions.
  • Utilizes data driven decision making.
  • Ensures that direct reports have adequate knowledge of evidence-based practices and which evidence-based practices are offered by providers in network; makes certain that evidence-based practices are routinely discussed in supervision between Clinical Supervisors and Clinical Care Managers.
  • Models and requires exceptional customer service in work with members and providers.
  • Perform on-call duties as instructed.
  • Performs other duties as assigned.
Team Specific Responsibilities:
  • Ensures that Crisis Line team provides 24-hour utilization management by adequately trained care managers.
  • Oversees triage and referral for members in crisis, and timely resolution of crisis-related problems.
  • Monitors and ensures calls are answered in expected amount of time (30 seconds; 5 rings).
  • Implements protocols to ensure that Clinical Care Managers require appropriate risk assessment of members by providers.
  • Oversees prior authorization for all non-ambulatory levels of care.
  • Develops and monitors process for sharing members’ longitudinal history with providers and documentation of the communication.
  • Sets forth expectations that members’ care be carefully coordinated with teams providing longitudinal care management and that Clinical Care Managers assist in development of a care management plan.
  • Optimizes care management review of the member’s crisis plan with providers as applicable.
  • Collaborates with team and other departments to develop processes and protocols to assist in bed search for members.
  • Meets with providers to ensure collaboration and awareness of protocols, data monitoring and improvement of outcomes for members.
  • Promotes use of Evidence Based Practices with providers.
  • Delegates to Supervisors as needed.
  • Provides training on clinical care management operational procedures.
  • Engages in initiatives across agency and with external stakeholders related to promoting engagement and connection to appropriate behavioral health services for CBH members
Position Requirements:
  • Education: Master’s degree in Social Work or related field
  • License/Certification: License preferred; progress towards licensure within an agreed upon time frame as condition of continued employment. PA Child Abuse Clearance required.
  • Relevant Work Experience: Minimum of 3 years of post-graduate experience with a minimum of 1 year of supervisory experience.
Skills:
  • Strong verbal and written communication and presentation skills
  • Able to read, analyze and interpret utilization reports
  • Understanding of mental health and substance abuse services or interventions
  • Strong problem-solving skills
  • Proficient in MS Office and able to type at least 20 words per minute
  • Able to work collaboratively in team settings
  • Strong organizational skills
  • Compliant with HIPAA regulations
  • Strong clinical skills
  • Ability to provide clinical supervision related to complex clinical presentation of member
  • Critical thinking and clinical problem solving abilities
Philadelphia Residency Requirement:
  • The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.
U.S. Authorization Requirement:
  • CBH does not provide sponsorship for applicants requiring future work authorization. All candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future.
Equal Employment Opportunity:
  • We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CBH is an equal opportunity employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on all qualified individuals. This is without regard to race, ethnicity, creed, color, religion, national origin, age, sex/gender, marital status, gender identity, sexual orientation, gender identity or expression, disability, protected veteran status, genetic information or any other characteristic protected individual genetic information, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal, state, or local law.
Requesting An Accommodation:
  • CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed. If you are hired by CBH and require an accommodation to perform the essential functions of your role, you will be asked to participate in our accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodation once hired.
  • If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance, please send us an email at CBH.Recruitment@Phila.gov