Clinical Care Manager

COMMUNITY BEHAVIORAL HEALTH•Philadelphia, PA

36d•$65,600 - $67,100

About The Position

The Clinical Care Manager conducts utilization management, population management, cross-system consultation, provider management, and treatment quality monitoring. The role applies clinical knowledge of best practices and evidence-based treatments to support timely access to quality, medically necessary behavioral health services. When appropriate, the Clinical Care Manager consults with CBH Physician and Psychologist Advisors about treatment authorization. The position involves coordinating care with members, natural supports, providers, and community system partners; monitoring treatment and provider quality; documenting activities in CBH’s electronic system; and using data to inform clinical decisions. Team responsibilities include coordinating with behavioral and physical health providers and other community organizations, supporting integrated care plans, and facilitating longitudinal care management for assigned populations. The successful candidate must be a current Philadelphia resident or become one within six months of hire. The role requires travel within Philadelphia and surrounding counties and work in an adequately lighted and ventilated indoor environment. Regular activities may include walking, standing, stooping, bending, sitting, reaching, pushing, pulling, and repetitive wrist or hand movements. The employee must be able to use computers and office equipment and adapt to changing job demands.

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).
Obtain an LSW within nine months of employment and an LCSW, LPC, or LMFT within 36 months (three years) of employment.
At least three years of direct clinical care experience working with individuals and/or families in behavioral health settings, including assessment and treatment planning, and/or experience in a managed care setting.
Excellent clinical case conceptualization, meeting facilitation, proactive planning, and customer service skills.
Familiarity with medications, ASAM criteria, DSM criteria, and mental health and medical diagnoses.
Excellent verbal and written communication skills for working 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.
Ability to travel within Philadelphia and surrounding counties.
Ability to perform work involving walking, standing, stooping, bending, sitting, reaching, pushing, pulling, and repetitive wrist or hand movements.
Ability to use computers and office equipment and adapt to continuous changes and job demands.
Must be a current Philadelphia resident or become a resident within six months of hire.

Responsibilities

Apply knowledge of behavioral health services, system partners, the service continuum, and medical necessity criteria in work activities.
Complete utilization management activities, including interagency meetings, social determinants interviews, treatment team meetings, case consultations, care coordination, provider meetings, reviews, and treatment linkage.
Schedule and complete assigned activities daily and meet expected activity volumes and timeframes.
Authorize treatment when medical necessity criteria are met.
Consult with Physician Advisors, Psychologist Advisors, and clinical leadership when appropriate.
Generate denial letters based on physician reviews and in accordance with state regulations, as needed.
Work with members, natural supports, and community providers in accordance with CBH policies.
Coordinate care with system partners to address social determinants, barriers to wellness, and other member needs, including connection to community-based services.
Connect members with appropriate evidence-based treatments at admission, during treatment, and at discharge.
Monitor members’ length of treatment and work with providers and other systems to address barriers to treatment in less restrictive settings.
Collaborate with CBH departments to support quality care, appropriate service placement, and consistent longitudinal care management.
Document provider quality concerns in accordance with CBH policy and procedure.
Conduct provider meetings quarterly.
Use data to inform clinical decision-making and maintain documentation in CBH’s electronic system according to 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 when requested, cover peers’ work as assigned, and find coverage when absent.
Attend assigned meetings and prepare for and participate in supervision, Flash meetings, and Integrated Multidisciplinary Clinical Rounds.
Provide high-quality customer service to members, providers, and other stakeholders.
Demonstrate commitment to member- and family-driven care and principles of resiliency and recovery.
Participate in NIAC preparation and site visits as needed.
Maintain an accurate daily log of work completed and contribute to projects and other assigned duties.
Coordinate with external entities, including behavioral and physical health providers, Targeted Case Management, the Transitions, Integration and Partnerships Unit, housing providers, courts and probation, child welfare, and the School District of Philadelphia.
Address treatment engagement for assigned cohorts by reporting or addressing quality concerns, resolving communication barriers, assisting with mediation and clarification or prioritization issues, and promoting collaboration with providers and supports.
Assist with integrated care plans, including obtaining provider consents for information sharing and sharing plans with providers and members to promote collaboration with physical health providers and system partners.
Facilitate longitudinal care management for assigned populations.