Clinical Care Manager - Specialty Pop.

Community Behavioral Health.•Philadelphia, PA

19d

About The Position

The Specialty Populations Clinical Care Manager (CCM) is responsible for longitudinal care management and clinical oversight of members with complex behavioral health needs residing in high acuity and long-term residential settings. These settings include Extended Acute Care, Non-Hospital Extended Acute Care, Residential Treatment Facility for Adults, Long Term Structured Residences, Integrated Behavioral Health in Long- Term Care and Community Treatment Team - Clinically Supportive Living. This role ensures clinically appropriate and person-centered care through ongoing utilization management, provider collaboration, and system coordination. The Clinical Care Manager actively supports discharge planning, reduction of prolonged lengths of stay, and transitions to the least restrictive level of care, while addressing clinical, social, and legal barriers impacting member outcomes.

Requirements

Master’s degree in Social Work or a related clinical field.
PA Child Abuse Clearance required.
Required to obtain licensure within the first 18 months (1.5 years) of employment if not already licensed.
Candidates must have at least one of the following licenses: Licensed Social Worker (LSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW)
Minimum of 3 years of direct clinical care experience working with adults, children, adolescents, and/or their families in behavioral health settings.
Experience in assessment and treatment planning required.
Excellent clinical case conceptualization and treatment planning skills.
Strong communication skills, both verbal and written, with ability to collaborate across systems.
Excellent interpersonal and collaboration skills.
Ability to facilitate care team and interagency meetings.
Familiarity with medications and behavioral health terminology.
Strong customer service orientation.
Proactive planning and organizational skills.
Proficient in Microsoft Office (especially Excel); ability to type 40+ words per minute.
Strong time management skills; ability to multi-task and work independently or as part of a team.
Compliant with HIPAA and applicable clinical documentation standards.
Skills in conflict resolution, engagement, and clinical supervision/oversight of care coordination are essential.
Must be able to travel frequently In Philadelphia and surrounding counties.
The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.

Nice To Haves

Experience in managed care or utilization management preferred.
Prior experience in residential settings strongly preferred.

Responsibilities

Deliver longitudinal, integrated care management for assigned members across levels of care and systems.
Apply knowledge of behavioral health systems, service continuums, and medical necessity criteria in all clinical and administrative activities.
Collaborate with members, natural supports, and providers in communities, hospitals, and virtual environments.
Ensure Providers are using Evidence-based Practices in treatment planning for members.
Complete 8 -15 UM activities including interagency meetings, case consultations, provider communications, care coordination, treatment plan reviews, social determinants assessments, and treatment linkage.
Authorize services when medical necessity criteria are met; consult with Clinical Leadership and Physician Advisors as needed.
Generate insufficient and denial letters when appropriate, in accordance with regulations and CBH policy.
Monitor length of stay and work with providers to ensure timely transitions to less restrictive levels of care.
Facilitate cross-system care planning with behavioral health providers and other entities.
Conduct provider and stakeholder meetings, typically quarterly, to enhance collaboration and problem-solve care barriers.
Coordinate with CBH internal departments to promote continuity, quality of care, and appropriate service placement.
Coordinate with providers when appropriate to ensure that members ICP is shared with all their behavioral providers.
Maintain thorough and timely documentation in CBH’s electronic systems, in alignment with organizational and regulatory standards.
Report and document provider quality concerns per policy.
Use data to guide clinical decision-making and monitor care outcomes.
Respond to care coordination inquiries within 24–48 hours or sooner, as clinically indicated.
Maintain an accurate daily activity log and contribute to audits or site visits (e.g., NIAC) as needed.
Actively engage in individual and group supervision, case consultations, team meetings, and ongoing trainings.
Support team functions by assisting in onboarding new staff, covering team responsibilities during absences, and participating in special projects.
Ensure high-quality customer service and embody CBH values including member and family-driven care, resiliency, and recovery.
Demonstrate flexibility and adaptability to support the evolving needs of the team and population served.
Complete 8 -15 UM activities per day.
Conduct care coordination to support collaboration with system partners.
Participate in case reviews, provider meetings, and interagency discussions.
Review and process referrals for residential levels of care.
Support resolution of cross-system barriers impacting member care.
Manage a caseload of members with prolonged lengths of stay, communication, or accessibility needs,
Identify systemic and individual barriers impacting care progression.
Initiate and maintain discharge planning at admission, with ongoing updates throughout the length of stay.
Identify and address barriers to discharge, including clinical stabilization, housing availability, legal or forensic restrictions, and independent living skill deficits.
Collaborate with providers to develop actionable and realistic transition plans.
Facilitate movement to lower levels of care when clinically appropriate.
Ability to engage with members and providers onsite at provider location.