Clinical Care Manager
2 months ago
The Clinical Care Manager will be responsible for leading utilization management activities, population management, cross-system consultation, provider management, and treatment quality monitoring. This role requires a strong clinical knowledge of best practices and evidence-based treatments to ensure timely access to quality, medically necessary behavioral health services for Community Behavioral Health members.
Key Responsibilities- Conduct utilization review activities, including interagency meetings, social determinants interviews, treatment team meetings, case consultations, care coordination, provider meetings, reviews, and treatment linkage.
- Complete the expected number of utilization management activities per day/shift as specified under team-specific responsibilities in established timeframes.
- Authorize treatment when medical necessity criteria are met.
- Consult with physician advisors, psychologist advisors, and/or clinical leadership as clinically appropriate.
- Generate denial letters based on physician reviews and in accordance with state regulations as needed.
- Work directly with members, natural supports, and providers in the community during at least 6 days per month.
- Facilitate care coordination with system partners to address social determinants, barriers to wellness, and other needs of members, including connection to appropriate community-based services.
- 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 members receiving treatment in a less restrictive environment.
- Collaborate with other Community Behavioral Health 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 Community Behavioral Health policy/procedure.
- Conduct provider and/or stakeholder meetings at least quarterly.
- Use data to inform clinical decision-making.
- Maintain documentation in Community Behavioral Health's electronic system consistent with agency and industry standards.
- 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 consultations.
- Ensure the highest quality of customer service when interacting with members, providers, and other stakeholders.
- Participate in grievance/complaint hearings as assigned.
- Display commitment to member and family-driven care and principles of resiliency and recovery.
- Participate in National Institute of Mental Health (NIMH) preparation and site visits as needed.
- Maintain an accurate daily log of work completed.
- Contribute to projects and other duties as assigned.
- Complete concurrent reviews for bed-based services authorized for treatment by the Pre-Admission Screening (PAS) line.
- Complete an average of 8-15 utilization management activities per day.
- Review evaluations recommending preauthorized aftercare services within established timeframes.
- Education: Master's degree in Social Work or related field.
- License/Certification: License eligible and willing/able to obtain licensure within the first year of employment; PA Child Abuse Clearance required.
- 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.
- 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.
- Must be able to 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.
- The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.
- We strive to promote and sustain a culture of diversity, inclusion, and belonging every day. Community Behavioral Health 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 by applicable federal, state, or local law.
- Community Behavioral Health is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed. If you are hired by Community Behavioral Health 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.
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