Clinical Care Manager

The Clinical Care Manager is responsible for utilization management by conducting utilization review activities, population management, cross-system consultation, provider management and treatment quality monitoring.

The Clinical Care Manager must utilize clinical knowledge of best practices and evidence-based treatments, including Applied Behavior Analysis, for individuals with Autism spectrum and other neurodevelopmental disorders, 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 :

Depending upon your team assignment, some or all of these may apply.

· 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 and extend treatment authorizations when Medical Necessity Criteria is met.

· Consult with Physician Advisor, Psychologist Advisor and/or Clinical Supervisor as clinically appropriate.

· Generate denial letters based on physician consults and in accordance with state regulations as needed.

· Complete discharge reviews in a timely manner.

· Work directly with members, natural supports and providers in the community during 30-75% of work hours or 6-15 days per month.

· Facilitate care coordination 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 at admission, during treatment, and at discharge.

· Monitor member’s length of treatment and work collaboratively with providers and other systems to address barriers to member receiving treatment in a less restrictive environment.

· 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 meetings at least 4 times per year.

· Use data to inform clinical decision-making.

· Maintain documentation in CBH’s electronic system consistent with agency and industry standards.

· Understand and participate in grievance/complaint hearings as assigned.

· Respond to care coordination correspondence within 24-48 hours or sooner if necessary.

· Work collaboratively with team members including assisting with the training of newly hired employees as requested, covering work when peers are out of the office as assigned and finding coverage when absent.

· Attend all meetings as assigned and actively prepare for and participate in supervision and clinical case consultation.

· Maintain an accurate daily log of work completed.

· Contribute to projects and other duties as assigned.

Position Requirements:

· Education: Master’s degree in a closely related field (e.g., Social Work, Counseling)

· License/Certification: PA Child Abuse Clearance required.

· Relevant Work Experience: Minimum of 2 years direct clinical experience with children required, with experience in the provision of ABA services to individuals with Autism spectrum or other neurodevelopmental disorders strongly preferred.

Skills:

· Excellent clinical case conceptualization skills

· Meeting facilitation

· Proactive planning

· Customer service

· Flexibility and acceptance of change

· 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 in a fast-paced environment

· 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]

Job Type: Full-time

Pay: $65,600.00 - $67,100.00 per year

Benefits:

• 401(k)
• 403(b)
• 403(b) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Health insurance
• Health savings account
• Life insurance
• Mileage reimbursement
• Paid time off
• Parental leave
• Retirement plan
• Vision insurance

People with a criminal record are encouraged to apply

Application Question(s):

• Are you license eligible or and willing/able to obtain within 18 months (1.5) year of employment?
• This position requires a Philadelphia residency. Are you a resident of Philadelphia, or would be within 6 months of hire?
• This position provides services in the Philadelphia area; primarily traveling to various sites and homes within the City. Are you able and willing to travel throughout the city of Philadelphia?
• Is your Master's Degree in a Social Work or related field?

Education:

• Master's (Required)

Ability to Relocate:

• Philadelphia, PA 19107: Relocate before starting work (Required)

Work Location: Hybrid remote in Philadelphia, PA 19107