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Manager of Clinical Care for Adult Residential Services

2 months ago

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

The Clinical Care Manager oversees utilization management by performing utilization review tasks, managing populations, consulting across systems, overseeing providers, and monitoring treatment quality. This role 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. When clinically necessary, the Clinical Care Manager collaborates with Physician and Psychologist Advisors to authorize the most effective treatment for members.

Key Responsibilities:

  • Fulfill essential duties as outlined in this job description in a reliable, responsible, and positive manner, adhering to all relevant guidelines.
  • Exemplify professional conduct, language, skills, and appearance to effectively serve stakeholders, members, and their families.
  • Ensure compliance with organizational policies and procedures to deliver high-quality work in a culturally competent and cost-effective manner.
  • Foster diversity and acceptance within the organization and among all members and stakeholders by respecting their individuality and rights.
  • Propose and develop solutions to enhance work processes and innovative programs.
  • Participate actively in required meetings and complete all mandatory training sessions.
  • Maintain a high level of advocacy and confidentiality for members to support the organization's mission.
  • Report any suspected instances of fraud, waste, or abuse by providers or employees to ensure program integrity.

Essential Duties:

  • Possess comprehensive knowledge of behavioral health services, system partners, and established medical necessity criteria, applying this knowledge in all activities.
  • Conduct Utilization Management activities, including interagency meetings, social determinants interviews, treatment team meetings, and care coordination.
  • Meet the expected number of UM activities daily as specified under team responsibilities.
  • Authorize treatment when medical necessity criteria are satisfied.
  • Consult with Physician and Psychologist Advisors as clinically appropriate.
  • Draft denial letters based on physician reviews in accordance with regulations as necessary.
  • Facilitate care coordination with system partners to address social determinants and barriers to wellness.
  • Demonstrate an understanding of Evidence-Based Practices (EBPs) and connect members to appropriate treatments.
  • Monitor the duration of treatment and collaborate with providers to address barriers to less restrictive care.
  • Work with other departments to ensure quality care and promote appropriate service placements.
  • Document provider quality concerns in line with organizational policies.
  • Conduct meetings with providers and stakeholders at least quarterly.
  • Utilize data to guide clinical decision-making.
  • Maintain documentation in the electronic system according to agency and industry standards.
  • Respond to care coordination inquiries promptly.
  • Collaborate with team members, assisting in training new employees and covering responsibilities as needed.
  • Attend all assigned meetings and engage in supervision and clinical case consultations.
  • 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 required.
  • Keep an accurate daily log of completed work.
  • Contribute to special projects and other assigned duties.

Team-Specific Duties:

  • Complete UM activities for adult members in 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 providers of adult residential services as assigned.
  • Collaborate with the forensic system for members involved in rehabilitation services.

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 skills.
    • Excellent customer service orientation.
    • Familiarity with medications.
    • Strong verbal and written communication skills.
    • Excellent interpersonal and collaboration skills.
    • Proficient in MS Office, particularly Excel, with typing skills 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 designated areas may be required.
  • Regularly involves walking, standing, and other physical activities.
  • Ability to use computers and office equipment for daily responsibilities.
  • Work is typically performed indoors in well-lit and ventilated areas.
  • Adaptability to continuous changes and demands of the role is essential.

Commitment to Diversity:

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