Clinical Care Manager
7 days ago
We are seeking a skilled Clinical Care Manager to join our team at Community Behavioral Health. This role involves managing the utilization of services, ensuring timely access to quality care for our members.
About the RoleThe successful candidate will be responsible for conducting utilization review activities, population management, cross-system consultation, provider management, and treatment quality monitoring. They must utilize clinical knowledge of best practices and evidence-based treatments to ensure that our members receive appropriate care.
Main Responsibilities- Conduct utilization review activities, including interagency meetings, social determinants interviews with members, treatment team meetings, case consultations, care coordination, provider meetings, reviews, and treatment linkage.
- 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.
- Demonstrate an understanding of Evidence-Based Practices (EBPs) and connect members to appropriate evidence-based treatment.
- Monitor member length of treatment and work collaboratively with providers and other systems to address barriers to receiving treatment in a less restrictive environment.
- Masters degree in Social Work or related field
- Clinical licensure: Qualified candidates are required to obtain licensure within the first 18 months of employment; PA Child Abuse Clearance required
- Required licensure: PA Licensed Social Worker (LSW), PA Licensed Professional Counselor (LPC), PA Licensed Marriage and Family Therapist (LMFT), PA 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
The estimated salary for this role is $60,000-$80,000 per year, depending on qualifications and experience. We offer a comprehensive benefits package, including medical, dental, and vision insurance, as well as paid time off and holidays.
What We OfferAs a Clinical Care Manager at Community Behavioral Health, you will have the opportunity to work with a dedicated team of professionals who share your passion for delivering high-quality care to our members. We are committed to creating a positive and inclusive work environment that supports the growth and development of our staff. If you are a motivated and compassionate individual who is passionate about making a difference in the lives of others, we encourage you to apply for this exciting opportunity.
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