Coordinator, Care Management (High Risk & CBCM Team) - Hybrid

UPMC•Tobyhanna, PA

29d•Hybrid

About The Position

UPMC Community Care Behavioral Health is hiring a full-time Coordinator, Care Management for the High Risk and CBCM teams. This role will work in a hybrid structure with some time spent in the office each week and some travel throughout the community. The Coordinator of Care Management has over-all responsibility for managing daily operations on the floor. This individual is responsible for the clinical administrative supervision and management of the specified care management teams. The Manager ensures provision of clinical services consistent with all applicable policies and procedures. The Manager represents the organization to providers, member groups and families, and participates in overall clinical operations management as warranted.

Requirements

Pennsylvania licensure and Master's degree in health-related field OR licensed RN with Bachelor's degree in nursing or related field.
5 years of clinical behavioral health experience.
Pennsylvania licensure: LSW, LCSW, LPC, licensed MFT, licensed RN and/or a licensed PhD (psychologist)
Act 33 with renewal
Act 34 with renewal
Act 73 FBI Clearance with renewal
Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state.

Nice To Haves

Management/leadership experience in behavioral health preferred.
Experience in managed care strongly preferred
General knowledge of best practices in behavioral health, emphasizing work with special needs populations and in public sector systems.
Strong working knowledge of managed care functional areas, including terms and definitions.

Responsibilities

Manage assigned caseload.
Demonstrates leadership.
Responsible for directly assisting daily operations of the unit when scheduled staff are unable to perform their duties.
Maintains an up-to-date understanding of benefits, in-plan services, and the regulatory environment and remains current on covered benefits, limitations, exclusions, and policies and procedures.
Coordinates, reviews and maintains data for reporting purposes and for weekly preparation and analysis of trending reports.
Participates in CQI activities and provider training, and participates in professional development activities.
Coordinates the complaint and grievance process for members.
Works with Network Management and Quality Management staff to assure that systematic revisions to improve services are developed and implemented.
Works with internal network staff and providers to identify opportunities for the development of alternative or non-traditional services to best meet members' needs.
Works as part of the management team in collaboration with Member Services, Network Management and Quality Management departments to assure that systematic revisions to improve services are developed and implemented.
Attends case conferences, interagency and provider treatment planning meetings for members when the assigned care manager is unavailable or when the assigned care manager requires clinical administrative support.
Meets with members and families, primary care and behavioral health providers, and other agency staff as needed to develop and coordinate services.
Knowledge of Community Resources.
Works closely with the director in the continued development of the care management department.
Demonstrates excellent clinical, written and oral communication skills.
Monitors daily activity to ensure that services of the department are provided within standards.
Provides accurate information concerning benefits and coverage to staff or other persons as required.
Receives and responds to complex calls to assist in their resolution.
Responsiveness to deadlines and has work completed on or before deadline 95%25 of the time.
Assumes daily responsibility for the access and quality of services provided to Community Care members through the care management department.
Supervises collection of information regarding the delivery and outcomes of Community Care services to members, and uses that information to recommend modifications to plan policies and procedures intended to improve the delivery of services to members.
Provides oversight of the teams providing clinical reviews, service authorization, and care coordination for all Community Care members.
Responsible for providing after-hours call support and supervision as required by the scheduled personnel.
Proposes and implements creative solutions to problems and to achieve a high level of member satisfaction with services.
Adheres to guiding principles of the organization.
Acts with the authority of the Director of Care Management and Member Services when designated.
Participates in making presentations to participating providers, state and federal agencies, community groups and other interested parties.
Utilizes supervision effectively. Reports clinical, utilization and outcomes issues to Director of Care Management and Member Services. Identifies provider issues and recommendations for improvement.
Independently problem solves based on sophisticated knowledge of behavioral health services for children and adults, the provider network, policies, members' rights and responsibilities, and the operating practices of the organization.
Advanced clinical knowledge.
Well-organized, reliable and dependable.