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Integrated Care Management Consultant

2 months ago

Philadelphia, Pennsylvania, United States Community Behavioral Health. Full time
Job Overview

The Integrated Care Management Consultant plays a vital role in delivering clinical insights and collaborative assistance to team members and healthcare professionals engaged in the Integrated Care Plan (ICP) Program. This position involves a thorough review of clinical data through a comprehensive care lens, offering recommendations for suitable care levels, developing Integrated Care Plans, and orchestrating services for individuals referred to the ICP team.

Key Responsibilities:

  • The consultant will travel to designated community partnership locations and engage in scheduled case information exchanges.
  • They will establish a visitation schedule with each practice site, PH MCO, and CBH team personnel to obtain consent from members for participation in the Integrated Care Plan Program, share relevant information with the PH MCO, and discuss case recommendations with the appropriate internal teams.
  • Completion of Integrated Care Plans will be conducted in accordance with the policies and regulations set forth by CBH and state guidelines.
  • Creation of Integrated Care Plans will be undertaken for members referred from community partners, internal referrals for ICP development, and for individuals meeting the criteria for integrated care planning.
  • During collaborative case discussions with sites and PH MCOs, the consultant will provide insights on behavioral health treatment utilization and develop care plans tailored to the individual's immediate needs as part of the treatment team.
  • Coordination with internal CBH staff will ensure clear communication and collaboration, facilitating the implementation of the developed care plan.
  • Participation in problem-solving initiatives and provision of information on additional community resources will be expected as needed.
  • Utilization reviews will be conducted as necessary for assigned members, applying medical necessity criteria to inform level of care decisions.
  • Documentation and tracking of interventions will be required, along with sharing data internally and with associated partners, such as PH MCOs and community partnership sites.

Qualifications:

  • Education: A Master's degree in Social Work or a related discipline.
  • License/Certification: A license is preferred or must be eligible within one year of hire; PA Child Abuse Clearance is mandatory; additional health-related clearances may be required based on community site partnerships.
  • Experience: A minimum of three years of direct clinical care experience with adults in behavioral health or physical health environments; experience in assessment and treatment planning and/or in a managed care context is essential. Knowledge of evidence-based treatment for behavioral health issues is necessary for making appropriate referrals.

Skills:

  • Ability to collaborate effectively with cross-system partners.
  • Exceptional verbal and written communication skills, with the capacity to engage a diverse range of individuals.
  • Strong mediation and negotiation skills.
  • Proficiency in computer use and the ability to type at least 20 words per minute.
  • Capability to work independently in a dynamic environment.
  • Adherence to HIPAA regulations is essential.

Work Environment:

  • This role primarily involves fieldwork, necessitating travel within the designated service areas.
  • Regular physical activities include walking, standing, bending, sitting, reaching, and repetitive hand movements throughout the workday.
  • Utilization of computers and office equipment is required to fulfill daily responsibilities.
  • Continuous normal hearing and vision are necessary for this position.
  • Work is typically conducted indoors in adequately lit and ventilated areas, with some temperature fluctuations. No special protective equipment is routinely required.
  • Adaptability to ongoing changes and demands of the role is crucial.

Equal Employment Opportunity:

Community Behavioral Health is committed to fostering a culture of diversity, inclusion, and belonging. We are an equal opportunity employer and do not discriminate in any personnel action based on race, ethnicity, creed, color, religion, national origin, age, sex/gender, marital status, gender identity, sexual orientation, disability, or any other characteristic protected by law.