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Manager of Clinical Care for Adult Residential Services

2 months ago

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

The Clinical Care Manager plays a crucial role in overseeing utilization management by executing utilization review processes, managing populations, consulting across systems, overseeing provider relations, and monitoring treatment quality. This position requires the application of clinical expertise in best practices and evidence-based treatments to guarantee that members receive prompt access to essential behavioral health services.

Key Responsibilities:

  • Execute primary duties as outlined in this job overview in a reliable, responsible, and positive manner, adhering to all relevant state and federal regulations.
  • Serve as a professional example by demonstrating appropriate behavior, language, skills, and appearance to effectively meet the needs of stakeholders, members, and their families.
  • Ensure compliance with organizational policies and procedures to maintain high-quality work delivered in a culturally competent and cost-effective manner.
  • Foster diversity and acceptance within the organization and among all members and stakeholders by honoring their individuality and rights.
  • Propose and develop solutions to enhance work processes and innovative programs.
  • Actively engage in required meetings and complete all necessary training sessions.
  • Uphold high standards of advocacy and confidentiality to support the organization's mission.
  • Assist in maintaining program integrity by being vigilant and reporting any suspected instances of fraud, waste, or abuse.

Essential Duties:

  • Possess comprehensive knowledge of behavioral health services, system partners, service continuum, and established medical necessity criteria, applying this knowledge in all job functions.
  • Conduct Utilization Management activities, including interagency meetings, social determinants interviews, treatment team meetings, case consultations, and care coordination.
  • Meet the expected number of UM activities daily as specified in team responsibilities within established timeframes.
  • Authorize treatment when medical necessity criteria are satisfied.
  • Consult with Physician and Psychologist Advisors as clinically appropriate.
  • Draft denial letters based on physician evaluations and in accordance with state regulations when necessary.
  • Facilitate care coordination with system partners to address social determinants and barriers to wellness, connecting members to suitable community-based services.
  • Demonstrate understanding of Evidence-Based Practices (EBPs) and link members to appropriate treatments at various stages of care.
  • Monitor treatment duration and collaborate with providers to address barriers to receiving care in less restrictive environments.
  • Work with other departments to ensure quality care and promote appropriate service placements.
  • Document provider quality concerns per organizational policy.
  • Conduct quarterly meetings with providers and stakeholders.
  • Utilize data to guide clinical decision-making.
  • Maintain documentation in the electronic system in line with agency and industry standards.
  • Respond to care coordination inquiries promptly.
  • Collaborate with team members, assisting in training new hires and covering responsibilities as needed.
  • Attend all assigned meetings and actively participate in supervision and clinical case discussions.
  • Provide exceptional customer service when interacting with members, providers, and stakeholders.
  • Commit to member and family-driven care principles.
  • Participate in preparation and site visits as necessary.
  • Keep an accurate daily log of completed work.
  • Contribute to projects and additional duties as assigned.

Team-Specific Duties:

  • Complete UM activities for adult members in managed community-based treatment settings, including reviews and care coordination.
  • Achieve an average of 17-19 UM activities daily.
  • Coordinate with housing system stakeholders to support members in permanent supportive housing.
  • Manage assigned providers of adult residential services.
  • Collaborate with the forensic system for members involved in Behavioral Health Justice Rehabilitation Services.

Position Qualifications:

  • Education: Master’s degree in Social Work or a related field, or Registered Nurse.
  • License/Certification: Eligible for licensure and willing to obtain it within the first year; 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).
  • Experience: Minimum of 3 years of direct clinical care experience in behavioral health settings.
  • Skills:
    • Strong clinical case conceptualization abilities.
    • Effective meeting facilitation.
    • Proactive planning and customer service skills.
    • Familiarity with medications.
    • Excellent verbal and written communication skills.
    • Strong interpersonal and collaboration skills.
    • Proficient in MS Office, particularly Excel, with typing speed of at least 40 words per minute.
    • Able to work independently and as part of a team.
    • Strong time management and prioritization skills.
    • Compliance with HIPAA regulations.

Work Environment:

  • Travel within the designated service area is required.
  • Regularly involves walking, standing, and other physical activities throughout the day.
  • Ability to use computers and office equipment for daily responsibilities.
  • Work is primarily indoors in well-lit and ventilated areas.
  • Must adapt to continuous changes and demands of the role.

Equal Employment Opportunity:

The organization is committed to fostering a culture of diversity, inclusion, and belonging. We are an equal opportunity employer and do not discriminate based on any protected characteristic.