Clinical Care Manager ASAM

Community Behavioral Health.•Philadelphia, PA

41d•$65,600 - $67,100

About The Position

The Clinical Care Manager is responsible for utilization management through utilization review activities, population management, cross-system consultation, provider management, and treatment quality monitoring. The role uses clinical knowledge of best practices and evidence-based treatments to help ensure CBH members receive timely access to quality, medically necessary behavioral health services. When clinically indicated, the Clinical Care Manager consults with CBH Physician and Psychologist Advisors to ensure the most effective treatment is authorized. The position includes direct work with members, natural supports, providers, and community partners; care coordination to address social determinants and barriers to wellness; and monitoring treatment length and transitions to less restrictive settings. The Clinical Care Manager maintains accurate documentation and work logs, uses data to inform clinical decisions, supports consistent longitudinal care management, and contributes to team activities and projects. The successful candidate must be a current Philadelphia resident or become one within six months of hire. Candidates need a master’s degree in Social Work or a related field, relevant clinical or managed-care experience, knowledge of ASAM Medical Necessity Criteria, and the required licensure. An LSW must be obtained by nine months of employment, and candidates are required to obtain an LCSW, LPC, or LMFT within two years of employment.

Requirements

Master’s degree in Social Work or a related field.
Required licensure: Licensed Social Worker (LSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), or Licensed Clinical Social Worker (LCSW).
LSW must be obtained within nine months of employment.
Qualified candidates are required to obtain an LCSW, LPC, or LMFT within two years of employment.
PA Child Abuse Clearance required.
Minimum of three years of direct clinical care experience working with adults, children, adolescents, and/or their families in behavioral health settings, with experience in assessment and treatment planning; and/or experience in a managed care setting.
Knowledge of ASAM Medical Necessity Criteria.
Excellent clinical case conceptualization skills.
Meeting facilitation skills.
Proactive planning skills.
Customer service skills.
Familiarity with medications.
Excellent verbal and written communication skills for communicating with internal and external stakeholders.
Excellent interpersonal and collaboration skills.
Proficiency in MS Office, especially Excel, and ability to type at least 40 words per minute.
Ability to work independently and as part of a team.
Excellent time management and prioritization skills, with ability to multitask.
Compliance with HIPAA regulations.
Must be a current Philadelphia resident or become a Philadelphia resident within six months of hire.

Responsibilities

Apply knowledge of behavioral health services, system partners, service continuum, and established medical necessity criteria in work activities.
Complete utilization management activities, including interagency meetings, social determinants interviews with members, treatment team meetings, case consultations, care coordination, provider meetings, reviews, and treatment linkage.
Complete the expected number of utilization management activities per day or shift within established timeframes.
Authorize treatment when Medical Necessity Criteria is met.
Consult with Physician Advisors, Psychologist Advisors, and/or Clinical Leadership when clinically appropriate.
Generate denial letters based on physician reviews and in accordance with state regulations as needed.
Work directly with members, natural supports, and community providers at least six days per month.
Coordinate care with system partners to address social determinants, barriers to wellness, and member needs, including connections to appropriate community-based services.
Use knowledge of Evidence-Based Practices to connect members to appropriate evidence-based treatment at admission, during treatment, and at discharge.
Monitor members’ length of treatment and collaborate with providers and other systems to address barriers to treatment in a less restrictive environment.
Collaborate with other CBH departments to support quality of care, appropriate service placement, and consistent longitudinal care management.
Document provider quality concerns in accordance with CBH policies and procedures.
Conduct provider and/or stakeholder meetings at least quarterly.
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 when necessary.
Collaborate with team members, assist with training newly hired employees as requested, cover work when peers are out as assigned, and arrange coverage when absent.
Attend assigned meetings and actively prepare for and participate in supervision and clinical case consultations.
Provide high-quality customer service to members, providers, and other stakeholders.
Participate in grievance and complaint hearings as assigned.
Support member- and family-driven care and the principles of resiliency and recovery.
Participate in NIAC preparation and site visits as needed.
Maintain an accurate daily log of work completed.
Contribute to projects and perform other duties as assigned.
Complete concurrent reviews for bed-based services authorized for treatment by the PES line.
Review evaluations recommending preauthorized aftercare services within established timeframes.