Licensed Professional Care Manager (Camp Hill, PA)

UPMC•Camp Hill, PA

2d•Hybrid

About The Position

UPMC Community Care Behavioral Health is hiring a Licensed Professional Care Manager for the Camp Hill region. The role is hybrid, with most time spent working remotely and traveling throughout the community; occasional office presence may be needed. Mileage is reimbursed at the IRS rate. The Care Manager supports members at risk for recidivism or discontinuous care, and members in priority or special-needs populations who have complex behavioral health coordination needs. The role helps assigned members access care across the continuum and conducts required pre-certification, continued-stay, discharge, service-authorization, and care-coordination activities in accordance with Community Care policies and procedures. Care Managers represent the organization to providers, member groups, and families, and contribute to clinical operations with clinical leadership based on relevant practice expertise, education, training, and experience. A Care Manager may also serve as a care-management lead for team members. Title and salary for a Senior Professional Care Manager are determined based on education and care-management experience.

Requirements

Pennsylvania licensure in a health or human-services field and a master’s degree, or licensed RN (BSN preferred), or Licensed Behavior Specialist for IBHS levels of care only.
Current, unrestricted Pennsylvania licensure as an RN, LSW, LCSW, LPC, licensed MFT, or licensed PhD psychologist; Licensed Behavior Specialist is accepted for IBHS levels of care only.
At least three years of relevant clinical experience.
Automotive insurance.
Valid driver’s license.
Act 33 clearance, with renewal.
Act 34 clearance, with renewal.
Act 73 FBI clearance, with renewal.
For nursing licensure, current licensure in the facility’s state or an eligible multistate license under the Nurse Licensure Compact; employees who move into the facility’s state on an out-of-state NLC license must apply for state licensure within 60 days of changing residency.
Excellent clinical, written, and oral communication skills.
Clinical skills and a sophisticated understanding of the overall needs of assigned members.

Nice To Haves

Preference is given to licensure other than Licensed Behavior Specialist.
Managed-care experience is strongly preferred.
General knowledge of behavioral-health best practices, particularly work with special-needs or priority populations and public-sector systems.
Certified Addiction Counselor (CAC) or Certified Alcohol and Drug Counselor (CADC) certification is helpful.
Supervisory or other behavioral-health leadership experience is preferred.
BSN is preferred for licensed RNs.

Responsibilities

Make independent authorization determinations for medically necessary services within the scope of the held license.
Apply knowledge of clinical treatment, case management, and community resources.
Encourage coordination of care with primary care physicians and other providers involved in members’ lives.
Monitor treatment and service-plan effectiveness and outcomes, and recommend modifications to support clinically appropriate care and community maintenance at the least restrictive level.
Assist members with transitions into or out of the county.
Complete work on or before deadlines at least 95% of the time.
Develop outreach plans for assigned members who do not maintain regular contact with behavioral health providers.
Implement clinical interventions to support optimal clinical and quality outcomes.
Coordinate with Member Services, Network Management, and Quality Management staff to develop and implement service improvements.
Coordinate information and make presentations to participating providers, government agencies, community groups, and other interested parties.
Identify provider issues and recommend improvements.
Manage a designated caseload across the continuum of care.
Provide members, providers, and other stakeholders with accurate information about behavioral health benefits and coverage.
Facilitate connections among members, families, primary care and behavioral health providers, and social-service or other provider agencies to develop and coordinate service plans.
Maintain contact with members and refer them to community-based case-management services as appropriate.
Consult physician advisors as needed for case collaboration and care planning.
Attend case conferences, interagency meetings, and provider treatment-planning meetings for assigned members.
Participate in professional development activities and contribute clinical expertise to the care-management team and Member Services staff.
Oversee collection of information about service delivery and outcomes, and use it to recommend policy and procedure changes that improve services.
Coordinate, review, and maintain daily logs for reporting and weekly trend-report preparation and analysis.
Collaborate with providers and others to obtain initial assessments, treatment plans, and aftercare plans.
Conduct or oversee clinical reviews, service authorizations, and care coordination for assigned members receiving behavioral health services.
Independently problem-solve using advanced knowledge of the service-delivery system, provider network, member-service policies, member rights and responsibilities, and organizational practices.
Develop and implement solutions to member problems and improve member satisfaction with services.
Maintain current knowledge of behavioral health benefits, covered services, limitations, exclusions, and applicable policies and procedures.
Use regular supervision with the medical director and clinical manager.
Participate in continuous quality improvement activities and provider training.
Work with members and providers to customize services within Community Care’s obligations to members.
Receive and respond to complex and crisis calls.
Respond to member and provider complaints according to Community Care policies and procedures.