Clinical Care Manager

Community Behavioral Health.•Philadelphia, PA

3d•Hybrid

About The Position

The Clinical Care Manager is responsible for care coordination, population management, cross-system consultation, provider management, treatment quality monitoring and potentially utilization management. The Clinical Care Manager must utilize clinical knowledge of best practices and evidence-based treatments to ensure CBH members receive timely access to quality, medically necessary behavioral health services. When clinically indicated, Clinical Care Managers consult with CBH Physician and Psychologist Advisors to ensure the most effective treatment for the CBH member is being authorized. The Clinical Care Manager will work to enhance physical and behavioral health care coordination and assist with mitigating social determinants of health (SDOH).

Requirements

Master’s degree in Social Work or related field
License eligible and willing/able to obtain licensure within the first year of employment
PA Child Abuse Clearance required
Community Based/Clinic Setting 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 a current Philadelphia resident or become a resident within six months of hire.

Nice To Haves

Preferred Licensure: Licensed Social Worker (LSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW)
Strong communication skills

Responsibilities

Be knowledgeable about behavioral health care services, system partners, service continuum and established medical necessity criteria and apply that knowledge in all work activities.
Work directly with members, natural supports and providers in the community.
Facilitate care coordination.
Using an inter-generational approach, with system partners to address social determinants, barriers to wellness, and other needs of members, including connection to appropriate community based services.
Complete Utilization Management activities including but not limited to: interagency meetings, social determinants interviews with members, treatment team meetings, case consultations, care coordination, provider meetings, reviews, treatment linkage.
Complete expected number of care coordination and/or UM activities per day/shift as specified under team specified under team specific responsibilities in established timeframes.
Authorize treatment when Medical Necessity Criteria is met.
Consult with Physician Advisor, Psychologist Advisor and/or Clinical Leadership as clinically appropriate.
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 to facilitate consistent longitudinal care management.
Document provider quality concerns in accordance with CBH policy/procedure.
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 if necessary.
Work collaboratively with the on-site inter-disciplinary team.
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.
Generate denial letters based on physician reviews and in accordance with state regulations as needed.
Contribute to projects and other duties as assigned.
Complete an average of 8-15 care coordination/UM activities per day.
Facilitate care coordination with external stakeholders and system partners and providers.
Complete documentation and plans to promote collaboration with physical health providers and system partners.
Complete majority of these team specific activities while co-located in a hospital and/or primary care setting