Clinical Care Manager
4 days ago
We are seeking a highly skilled Clinical Care Manager to join our team at Community Behavioral Health. As a Clinical Care Manager, you will be responsible for providing utilization management services to individuals with neurodevelopmental disorders, including Autism Spectrum Disorder. Your primary goal will be to ensure that our members receive timely access to quality, medically necessary behavioral health services.
Key Responsibilities- Conduct utilization review activities, including interagency meetings, social determinants interviews, treatment team meetings, and case consultations.
- Complete expected number of utilization management activities per day/shift as specified under team-specific responsibilities.
- Authorize and extend treatment authorizations when Medical Necessity Criteria is met.
- Consult with Physician Advisor, Psychologist Advisor, and/or Clinical Supervisor as clinically appropriate.
- Generate denial letters based on physician consults and in accordance with state regulations as needed.
- Complete discharge reviews in a timely manner.
- Work directly with members, natural supports, and providers in the community during 30-75% of work hours or 6-15 days per month.
- Facilitate care coordination with system partners to address social determinants, barriers to wellness, and other needs of members.
- Demonstrate an understanding of Evidence-Based Practices (EBPs) and connect members to appropriate evidence-based treatment at admission, during treatment, and at discharge.
- 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 meetings at least 4 times per year.
- Use data to inform clinical decision-making.
- Maintain documentation in CBH's electronic system consistent with agency and industry standards.
- Understand and participate in grievance/complaint hearings as assigned.
- 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 consultation.
- Maintain an accurate daily log of work completed.
- Contribute to projects and other duties as assigned.
- Manage ABA-Designated Providers within the IBHS Level of Care, consult to teams managing other Levels of Care as needed or assigned.
- Complete an average of 8-15 utilization management activities per day.
- Complete reviews of service authorization requests, including review of Written Orders, Physician consultation per Review Guidelines, provider notification, referral submission (if required), denial letter (if required), authorization generation (if required), and log of review.
- Participate in at least 8 inter-agency or inter-disciplinary team meetings per month for members being recommended for or receiving ABA Services.
- Ensure collaboration and continuity of care for members with multiple services or in multiple child-serving systems.
- Facilitate collaboration with community-based treatment team for members experiencing a crisis.
- Conduct crisis consultations for members receiving ABA, as needed, including supporting member through access to higher levels of care and return to community-based services.
- Conduct progress monitoring reviews for members in need of intensive care management, or as indicated by provider outlier performance.
- Complete service authorizations completely and accurately, as assigned.
- Implement provider management strategies, including review of metrics and key performance indicators, promoting transparent dialogues with all providers with regards to any compliance or outlying performance concerns.
- Education: Master's degree in Applied Behavior Analysis, Psychology, or Special Education preferred. Master's degree in a closely related field (e.g., Social Work, Counseling) with at least 18 credits in graduate-level coursework in ABA accepted.
- License/Certification: BCBA or BCBA-eligible within 18 months (1.5 years) of accepting position preferred. If not BCBA or BCBA-eligible, MUST have Pennsylvania License as a Behavior Specialist (BSL).
- PA Child Abuse Clearance required.
- Relevant Work Experience: Minimum of 2 years direct clinical experience with children required, with experience in the provision of ABA services to individuals with Autism Spectrum or other neurodevelopmental disorders strongly preferred.
- Excellent clinical case conceptualization skills.
- Meeting facilitation.
- Proactive planning.
- Customer service.
- Flexibility and acceptance of change.
- 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 in a fast-paced environment.
- Commitment to professional ethics code (e.g., BACB, APBA).
- Compliant with HIPAA regulations.
- 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.
- 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.
- 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
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