CLINICAL MANAGER

UHS

About The Position

General summary: The Clinical Manager (CLM) of the Behavioral Health Contact Center is responsible for the depth of the clinical interventions with people that require telephone counseling. CLM is responsible for crisis and emergency management and recommends the alternate care levels leading to a rehabilitation plan. Establish direct communication with leaders and representatives of the Behavioral Health Contact Center, with persons within FHC, mental health clinics, and with the divisions of the integrated system to guarantee the continuity of care. Consults with psychiatrists the more complex cases. Offers support to Case Managers and to all the efforts related to complying with handling the phone calls. The Clinical Manager is responsible for telephonic counseling, managing referrals and providing support in the coordination and notification of appointments scheduled for our members, in accordance with the timeframes established in the organization's policies. This role also ensures accessibility and quality of care for our members.

Requirements

Master’s in Social Work, Psychology, Psychological Counseling, Mental Health Counseling, or Psychiatric Nursing
Valid and current active license for Social Work, Psychiatric Nursing, Psychological Counseling, Psychology, or Mental Health Counseling
Professional membership certification (colegiación): Valid membership for Social Work and Psychiatric Nursing
Relevant Work Experience: Two or more years of experience in the health field.
Knowledge in Microsoft Office

Nice To Haves

Preferable fully bilingual

Responsibilities

Upon answering, CLM must identify themselves by name, title, and organization’s name following FHC Behavioral Health Contact Center Standards.
Answer incoming calls within the company’s established time frame, using a clear, pleasant tone and appropriate language.
Shows appropriate communication skills, effective listening, and case management skills to deal with challenging situations.
Verifies the member eligibility before processing and registering the phone call in FHC’s platforms.
Ensures that member consent is obtained and documented.
Provide support to members calling the Behavioral Health Contact Center by conducting needs assessments, brief interventions, facilitating referrals and supportive engagement.
Have immediate access to director or clinical supervisor.
Consult with Behavioral Health Contact Center psychiatrists and/or licensed clinicians whenever necessary.
Offers psychological counseling through the phone to the people who are referred.
Offers intervention for psychiatric crisis or emergency management.
Intervention with emergency services (e.g., 911, mobile crisis units) when immediate action is required and provides follow-up for all emergency calls.
Follow-up call for crisis or emergencies 24 hours after the coordination of services to assure the continuity of care.
Follows internal protocols for mandatory reporting, including cases involving abuse, neglect, or threats to self/others.
Educates the member or authorized representative about our programs and coverage’s benefits.
CLM uses the Triage Logic platform to identify the most appropriate level of care and counsels and informs the person about the various options of service available for his or her rehabilitation.
Refers callers to appropriate services, including outpatient therapy, inpatient care, or community-based resources.
Facilitate access to immediate services if an individual reports risk of suicidal or homicidal ideation or threats.
Provide solution-focused interventions such as helping member practice calming/coping skills, facilitating linkage to ongoing support, and explaining the mental health services available.
Refer and analyze with the psychiatrist special situations that require medical or clinical confirmation regarding the correctness of the final decision taken.
Consults with the psychiatrist matters related to the management of medications to make certain and validate the counseling that is going to be provided.
Maintains the confidentiality of the documents and the information received.
Documents according to the requirements of the Health Insurance Portability and Accountability Act (HIPAA) and Law 408.
Present cases to the physical facilities when the psychiatric hospital requests a medical evaluation prior to admission.
Authorizes the services of an ambulance in coordination with the existing criteria guide.
Facilitates the access of the person to the services for his or her rehabilitation and coordinates the necessary visits for the continuation of treatment.
The staff member is responsible for delivering all cases that require follow-up to the next shift, in accordance with established standards. Additionally, they must ensure that all cases from the previous shift are received in a complete and appropriate manner.
Timely Handover: All pending cases must be transferred before the end of the shift.
Compliance with Standards: Follow organizational protocols for case documentation and communication.
Verification: Confirm that cases received from the previous shift are complete and meet quality requirements.
Validate the registration process of the admissions to mental health services.
Enter the inpatient admission registration to the Registration Hospitalization Module when the facility cannot complete the task.
Assist members and/or providers with the transition of care by identifying resources to support the discharge plan.
Responsible for calling psychiatric inpatient facilities to validate admissions and discharges.
Responsible for entering information related to admissions and/or discharges on the Web Census platform.
CLM is responsible for identifying individuals who experience early or recurrent hospital readmissions to ensure appropriate follow-up care. Additionally, it identifies beneficiaries with high utilization of services and refers them to the Case Management Program for comprehensive support and intervention.
Receives and verify referrals for the coordination of appointments.
For MCS members, logs and generates the authorization of services in the PMHS application within 24 hours.
Escalate issues in a timely manner.
Discuss complex cases with Utilization Review and Case Management Departments.
Interacts with providers, members, and other professionals in charge of member’s care to validate continuity of service.
Comply with established quality parameters for abandonment rate, average speed of answer, coordination of services and notifications, calls classification and routing, and first call resolution.
Participates in the mandatory training, such as the Annual Compliance Plan, Human Resources & Departmental, URAC, NCQA and CMS guidelines.
Informs the supervisor or human resources of any sanction or revocation of your license that affects the practice of your profession.
Responsible for meeting daily with the representatives assign to his/her shift to establish the work strategies.
Provides leadership in clinical decisions for the public as well as the private sector.
Offers direct support to Case Managers.
Available for case analysis and for clinical decision-making.
Supports the Behavioral Health Contact Center Case Managers in the management of logistic issues that require more extensive intervention, such as problems with transportation, coordination with facilities, among others.
Complies with the established quality parameters, abandonment rate and average speed of answer, codify the first call resolution and CHRA services.
Carry out delegated duties such as: Outbound calls for the purpose of requesting information to verify next appointments, attendance at previous appointments, coordinate services and provide service authorizations number, if applicable. Faxing materials Mailing/e-mailing already identified materials. Follow up with referrals. TTY validation. Follow up Call Backs.