Clinical Care Management Specialist FOCUS
4 weeks ago
Community Behavioral Health is seeking a Clinical Care Management Specialist to join our team. As a Clinical Care Management Specialist, you will be responsible for providing intermediate or high-intensity care management to members and providers, ensuring effective and holistic care. You will work collaboratively with members, caregivers, and providers to develop individualized plans of care and ensure timely access to quality behavioral health services.
Key Responsibilities- Work directly with members, natural supports, and providers in the community, including in members' homes.
- Facilitate care coordination, using an inter-generational approach, to address social determinants, barriers to wellness, and other needs of members.
- Facilitate family Plan of Care meetings for assigned members monthly.
- Be knowledgeable about behavioral health care services, system partners, service continuum, and established medical necessity criteria, and apply that knowledge in all work activities.
- Complete Utilization Management activities, including interagency meetings, social determinants interviews with members, treatment team meetings, case consultations, care coordination, provider meetings, reviews, treatment linkage, within established timeframes.
- 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.
- Demonstrate an understanding of Evidence-Based Practices (EBPs) and connect members to appropriate evidence-based treatment.
- Collaborate with other CBH departments to ensure quality of care, promote placement of members in the most appropriate services, and to facilitate consistent longitudinal care management.
- Document provider quality concerns in accordance with CBH policy/procedure.
- 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.
- 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.
- Display commitment to member and family-driven care and principles of resiliency and recovery.
- Contribute to projects and other duties as assigned.
- Education: Master's degree in Social Work or related field.
- License/Certification: Willing/able to obtain licensure within first year of employment; PA Child Abuse Clearance required.
- Preferred Licensure: Licensed Social Worker (LSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW).
- Relevant Work Experience: 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.
- 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.
- Conflict and crisis management.
- Reliable, accountable, resourceful, curious, flexible, and creative.
- Empathetic (Accepting/non-judgmental).
- 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.
- Teamwork and Collaboration: Build and sustain relationships with co-workers and stakeholders and support efforts and deliverables. Encourage unity and help remove barriers to productivity and success.
- Respect: Treat each other and our members and stakeholders with respect and sensitivity, recognizing the importance of diversity.
- Member Centric: Focus on the needs of our members by providing value-added services, promoting strong relationships, and going beyond basic expectations to achieve the best possible outcomes.
- Honesty and Integrity: Be open and honest in all we do. Maintain the highest level of integrity at all times.
- Commitment to Service Excellence: Challenge ourselves to be forward-thinking and committed to providing total member and stakeholder satisfaction, first-in-class service, and high-quality, innovative programs.
- Compassion and Empathy: Demonstrate a deep appreciation for another's situation and point of view. Pay attention to emotional cues, listen effectively, and show an exceptional level of caring about each person's perspectives and circumstances.
- Problem Solving: Build and implement logical solutions to resolving challenges/issues by using individual knowledge and experience while taking resources, constraints, and CBH values into consideration.
- Initiative and Self-Directed: Proactively manage time and resources in a way that ensures that all work is done in the most efficient manner while identifying and implementing initiatives without interventions from co-workers, supervisors, or stakeholders.
- Flexibility and Adaptability: Adjust approaches and behaviors in order to meet the constantly changing environment head-on and accomplish CBH and individual goals. Strive to adapt to, accept, and embrace change within areas of responsibility.
- Communication: Effectively and appropriately share thoughts, ideas, and information - both written and oral. Respectfully listen to co-workers and stakeholders to gain a full understanding of issues/situations.
- Must be able to regularly 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.
- 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.
-
Clinical Care Management Specialist FOCUS
4 weeks ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timeJob Title: Clinical Care Management Specialist FOCUSCommunity Behavioral Health (CBH) is seeking a highly skilled Clinical Care Management Specialist to join our team. As a Clinical Care Management Specialist, you will play a critical role in providing intermediate or high-intensity care management to our members.Key Responsibilities:Work directly with...
-
Clinical Care Management Specialist Focus
4 weeks ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timeJob Title: Clinical Care Management Specialist FocusCommunity Behavioral Health (CBH) is seeking a highly skilled Clinical Care Management Specialist to join our team. As a Clinical Care Management Specialist, you will play a critical role in providing intermediate or high-intensity care management to our members.Job Summary:The Clinical Care Manager...
-
Clinical Care Management Specialist FOCUS
4 weeks ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timeJob Title: Clinical Care Management Specialist FOCUSCommunity Behavioral Health (CBH) is seeking a highly skilled Clinical Care Management Specialist to join our team. As a Clinical Care Management Specialist, you will play a critical role in providing intermediate or high-intensity care management to our members. Your expertise will be instrumental in...
-
Clinical Care Management Specialist
4 weeks ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timeJob SummaryCommunity Behavioral Health (CBH) is seeking a highly skilled Clinical Care Management Specialist to join our team. As a Clinical Care Management Specialist, you will play a critical role in providing high-intensity care management to children and families in need. This is a unique opportunity to make a meaningful difference in the lives of our...
-
Clinical Care Management Specialist
4 weeks ago
Philadelphia, Pennsylvania, United States Community Behavioral Health Full timeJob DescriptionThe Clinical Care Manager (CCM) Specialist is a key member of the Community Behavioral Health (CBH) team, responsible for providing high-intensity care management to children and adolescents with complex behavioral health needs. The CCM Specialist will work collaboratively with members, their caregivers, and providers to ensure effective,...
-
Clinical Care Management Specialist
4 weeks ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timeJob DescriptionThe Clinical Care Manager (CCM) Specialist - Complex Care is a critical member of our team, responsible for providing intermediate or high-intensity care management to our members. As a CCM Specialist, you will work collaboratively with members, providers, and other stakeholders to ensure effective, holistic, and member-centric care.Key...
-
Clinical Care Management Specialist
3 weeks ago
Philadelphia, Pennsylvania, United States Community Behavioral Health Full timeJob DescriptionThe Clinical Care Manager (CCM) Specialist is a critical member of our team, responsible for providing high-intensity care management to our members. This role requires a strong understanding of behavioral health care services, system partners, and established medical necessity criteria.Key Responsibilities:Work directly with members, natural...
-
Clinical Care Management Specialist
3 days ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timeClinical Care Management SpecialistWe are seeking a highly skilled Clinical Care Management Specialist to join our Complex Care team at Community Behavioral Health. As a key member of our team, you will be responsible for providing intermediate or high-intensity care management to individuals and families in need of support.Key Responsibilities:Conduct...
-
Clinical Nurse Specialist Critical Care Leader
4 weeks ago
Philadelphia, Pennsylvania, United States Temple University Hospital Full timeClinical Nurse Specialist-Critical CareCritical Care Clinical Nurse Specialists play a vital role in assessing and evaluating the clinical practices of nursing staff. In collaboration with the Director of Nursing, they identify areas for improvement and develop programs to address these needs. This role requires a high degree of professional excellence, with...
-
Clinical Care Specialist
3 weeks ago
Philadelphia, Pennsylvania, United States The Children's Hospital of Philadelphia Full timeJob SummaryThe Children's Hospital of Philadelphia is seeking a skilled Clinical Care Specialist to join our team. As a key member of our Lysosomal Storage Disorders Program, you will be responsible for providing high-quality patient care and management of metabolic disorders.ResponsibilitiesPrepare for clinic visits by reviewing patient information and...
-
Clinical Specialist
3 weeks ago
Philadelphia, Pennsylvania, United States Temple Health Full timeThe Clinical Specialist at Temple Health is responsible for delivering high-quality patient care based on the latest medical research and standards of their specialty.Using current empirical data, the Clinical Specialist collaborates with patients, family members, and healthcare teams to provide individualized care in a compassionate manner.The Clinical...
-
Nurse Manager
4 weeks ago
Philadelphia, Pennsylvania, United States Clinical Management Consultants Full timeLead the Way in Neonatal CareAs the Nurse Manager of our Neonatal Intensive Care Unit, you will be responsible for guiding nursing practices, overseeing staff management, and upholding care standards within the department. You will work closely with the Women's and Children's leadership to drive quality improvement efforts and manage the departmental...
-
Clinical Care Specialist
3 weeks ago
Philadelphia, Pennsylvania, United States Children's Hospital of Philadelphia Full timeJob SummaryThe Children's Hospital of Philadelphia is seeking a skilled Clinical Care Specialist to join our team. As a key member of our Lysosomal Storage Disorders Program, you will be responsible for providing high-quality patient care, collaborating with multidisciplinary teams, and contributing to research and education initiatives.Key...
-
Clinical Nurse Specialist Utilization Management
4 weeks ago
Philadelphia, Pennsylvania, United States The Children's Hospital of Philadelphia Full timeJob Title: Clinical Nurse Specialist Utilization ManagementChildren's Hospital of Philadelphia (CHOP) is seeking a highly skilled Clinical Nurse Specialist Utilization Management to join our team. As a key member of our Utilization Management department, you will play a critical role in ensuring that patients receive the most appropriate and effective...
-
Clinical Care Manager Specialist
3 weeks ago
Philadelphia, Pennsylvania, United States Community Behavioral Health Full timeJob SummaryWe are seeking a highly skilled Clinical Care Manager Specialist to join our Children's Complex Care team at Community Behavioral Health. As a key member of our team, you will be responsible for providing high-intensity care management to our members, working collaboratively with them and their providers to ensure effective, holistic, and...
-
Philadelphia, Pennsylvania, United States Jefferson Health Full timeJob Title: Clinical Documentation Improvement Specialist ManagerJefferson Health is seeking a highly skilled Clinical Documentation Improvement Specialist Manager to join our team. As a key member of our Health Information Management department, you will be responsible for leading the Clinical Documentation Improvement Program at Jefferson Hospital...
-
Clinical Care Specialist
3 weeks ago
Philadelphia, Pennsylvania, United States Children's Hospital of Philadelphia Full timeJob SummaryWe are seeking a highly skilled Nurse Practitioner to join our team at the Children\u0027s Hospital of Philadelphia. As a Clinical Care Specialist, you will provide high-quality, patient-centered care to a diverse population of children and families.Key ResponsibilitiesManage a cohort of patients, perform daily assessments, and develop...
-
Clinical Care Specialist
3 weeks ago
Philadelphia, Pennsylvania, United States The Children's Hospital of Philadelphia Full timeJob SummaryAs a Clinical Care Specialist at The Children's Hospital of Philadelphia, you will provide high-quality patient care as a Nurse Practitioner. In collaboration with an attending physician, you will work with a patient population that matches your skill set and collaborate with a range of healthcare professionals. You will engage in professional...
-
Clinical Nurse Specialist
3 days ago
Philadelphia, Pennsylvania, United States Temple Health Full timeJob DescriptionWe are seeking a skilled Clinical Nurse Specialist to join our team at Temple Health, where you will play a vital role in providing high-quality patient care in our outpatient setting.About the RoleThe Clinical Nurse Specialist will be responsible for assessing, implementing, and evaluating patient care under the direction of licensed...
-
Pharmacy Clinical Specialist
4 weeks ago
Philadelphia, Pennsylvania, United States Tower Health Full timeAbout the RoleThe Pharmacy Clinical Specialist is a key member of our team at Tower Health, responsible for delivering high-quality clinical pharmaceutical services to patients throughout the continuum. This role requires a strong focus on patient care, with a commitment to achieving the highest standards of care in pharmacy services related to specific...
