Clinical Care Management Specialist

Job Title: Clinical Care Management Specialist - Complex Care

Community Behavioral Health (CBH) is seeking a highly skilled Clinical Care Management Specialist - Complex Care to join our team. As a member of our Complex Care team, you will play a critical role in providing intermediate or high-intensity care management to our members.

Job Summary:

The Clinical Care Management Specialist - Complex Care will work collaboratively with members, providers, and other stakeholders to ensure effective, holistic, and member-centric care. This role requires a strong understanding of behavioral health care services, system partners, and established medical necessity criteria. The successful candidate will have excellent clinical case conceptualization skills, meeting facilitation, proactive planning, customer service, and communication skills.

Key Responsibilities:

• Work directly with members, natural supports, and providers in the community to facilitate care coordination and 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, and authorization of 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 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.

Requirements:

• 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.

Skills:

• 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.

Core Competencies:

• 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.

Work Conditions:

• 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.

U.S. Authorization Requirement:

• 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.

Equal Employment Opportunity:

• We strive to promote and sustain a culture of diversity, inclusion, and belonging every day. CBH 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 individual genetic information, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal, state, or local law.

Requesting An Accommodation:

• CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed. If you are hired by CBH 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.
• If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance, please send us an email at [insert email address].

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