Behavioral Health Care Coordinator

2 months ago

Philadelphia, Pennsylvania, United States Community Behavioral Health Full time
Job Summary

The Clinical Care Manager will be responsible for overseeing the utilization management process, ensuring that Community Behavioral Health members receive timely access to quality, medically necessary behavioral health services. This role requires a strong understanding of clinical best practices and evidence-based treatments.

Key Responsibilities
  • Conduct utilization review activities, including interagency meetings, social determinants interviews, treatment team meetings, and case consultations.
  • Complete concurrent reviews for bed-based services authorized for treatment by the PES line.
  • 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.
  • Work directly with members, natural supports, and providers in the community to address social determinants, barriers to wellness, and other needs of members.
  • Facilitate care coordination with system partners to address social determinants, barriers to wellness, and other needs of members.
  • Monitor member's length of treatment and work collaboratively with providers and other systems to address barriers to member receiving treatment in a less restrictive environment.
  • Collaborate with other CBH departments to ensure quality of care, promote placement of members in the most appropriate services, and facilitate consistent longitudinal care management.
  • Document provider quality concerns in accordance with CBH policy/procedure.
  • Conduct provider and/or stakeholder meetings at least quarterly.
  • 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.
  • Work collaboratively with team members, including assisting with the training of newly hired employees as requested, covering work when peers are out of the office as assigned, and finding coverage when absent.
  • 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.
  • Participate in grievance/complaint hearings as assigned.
  • Display commitment to member and family-driven care and principles of resiliency and recovery.
  • Participate in NIAC preparation and site visits as needed.
  • Maintain an accurate daily log of work completed.
  • Contribute to projects and other duties as assigned.
Requirements
  • Master's degree in Social Work or related field.
  • License eligible and willing/able to obtain licensure within the first year of employment.
  • PA Child Abuse Clearance required.
  • Licensed Social Worker (LSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW).
  • 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.
  • 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
  • Must be able to 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.
Philadelphia Residency Requirement
  • The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.

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