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Full-time
postgraduate degree
Posted 47d ago
~40 hrs/week
Responsibilities
The Clinical Care Manager coordinates care for members in integrated physical and community-based settings, focusing on mental health, substance use, and social determinants of health. Key duties include performing utilization management activities, authorizing treatments based on medical necessity, and collaborating with inter-disciplinary teams.
Requirements
Candidates must hold a Master's degree in Social Work or a related field and possess a relevant clinical license (LSW, LPC, LMFT, or LCSW). A minimum of 3 years of direct clinical care experience in behavioral health or managed care settings is required.
Full job description
The Clinical Care Manager is responsible for care coordination for members identified in integrated care physical health and community based settings who would benefit from connection to various mental health, substance use, and social determinants of health (SDOH).
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.
Essential Functions:
Be knowledgeable about behavioral health care services, system partners, service continuum and established medical necessity criteria and apply that knowledge in all work activities.
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 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.
Generate denial letters based on physician reviews and in accordance with state regulations as needed.
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.
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.
Contribute to projects and other duties as assigned.
Team Specific Responsibilities:
Complete an average of 8 - 15 activities per day.
Complete Level of Care (LOC), SDOH, and risk assessments
Facilitate care coordination with external stakeholders.
Complete integrated care plans to promote collaboration with physical health providers and system partners.
Position Requirements:
Education: Master's degree in Social Work or related field
Clinical Licensure: Qualified candidates are required to obtain license within the first 18 months (1.5 years) of employment; PA Child Abuse Clearance required
Required Licensure: Licensed Social Worker (LSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW)
Relevant Work 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
Skills:
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
Work Conditions (including travel, overtime required, physical requirements and occupational exposure):
Must be able to travel within Philadelphia and surrounding counties.
Regularly requires walking, standing, stooping, bending, sitting, reaching, pushing, pulling and/or repetitive wrist/hand movements for various lengths of time throughout the day.
Ability to utilize computers and office equipment to complete daily work responsibilities.
Regularly works inside in areas that are adequately lighted and ventilated. Some fluctuation in temperature. No protective equipment routinely needed.
Must be able to adapt to continuous changes/demands of the job.
Philadelphia Residency Requirement:
The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.
Equal Employment Opportunity:
We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CBH is an equal opportunity employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on all qualified individuals. This is without regard to race, ethnicity, creed, color, religion, national origin, age, sex/gender, marital status, gender identity, sexual orientation, gender identity or expression, disability, protected veteran status, genetic information or any other characteristic protected individual genetic information, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal, state, or local law.
Requesting An Accommodation:
CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed. If you are hired by CBH and require an accommodation to perform the essential functions of your role, you will be asked to participate in our accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodation once hired.
If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance, please send us an email at [email protected]
For more than 25 years, CBH has been expanding access to mental health services for Philadelphians.
Industry
Non-profit Organization Management
Company size
501-1,000 employees
Founded
1997
Headquarters
Philadelphia, PA
LinkedIn followers
8,739
CBH is a nonprofit 501 (c)(3) corporation contracted by the City of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services to manage the delivery of behavioral health services for Medicaid recipients of Philadelphia County. For more information about CBH, visit cbhphilly.org.
For more than 25 years, Community Behavioral Health (CBH) has been expanding access to mental health services for Philadelphians. CBH provides access to high-quality, accountable care to improve the health and mental wellness of our Members.
Our Mission:
CBH provides access to high-quality accountable care to improve the health and mental wellness of our members.
Our Vision:
Leading innovation in whole-person care for healthy, thriving communities.
Our Values:
We Care.
We value and appreciate our staff and service providers, believing that a healthy, happy workforce creates healthy, happy members. We show our appreciation regularly and listen to concerns. We also care deeply for the overall health of Philadelphians, knowing that a vibrant, thriving, resilient city hinges upon healthy citizens.
We Empower.
We are here for our employees, members, and partners. We are open and transparent, encouraging dialogue and fostering growth so we can all be our best, healthiest selves.
We Connect.
We’re updating our processes and technology to better serve our community and communicate more effectively and efficiently. We cultivate two-way communication, sharing our appreciation for our staff and welcoming feedback from them.
We Lead.
Behavioral and mental wellness is our passion, and we are experts in the field. We have been serving the Philadelphia community since 1997, and we know the industry. We cultivate close working relationships with our partners, who are also leaders in the mental health field. We are open to change and innovation to ensure the highest standard of care for all.
Offices: 801 Market Street, 7th Floor, Philadelphia, PA 19107, US
Behavioral Health Utilization ReviewHealth DiagnosticsHealth Care