Clinical Care Manager - Adult Acute Services

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 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 during at least 6 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 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 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 consultations. 
• Ensure highest quality of customer service when interacting with members, providers, and other stakeholders.
• Participate in grievance/complaint hearings as assigned.
• Display commitment to member and family driven care and principles of resiliency and recovery.
• Participate in NIAC preparation and site visits as needed.
• Maintain an accurate daily log of work completed.
• Contribute to projects and other duties as assigned.

Team Specific Responsibilities:

• Conduct initial, concurrent and discharge reviews for admissions into behavioral health care services using established medical necessity criteria
• Triage and review provider requests to determine medical necessity for service requests
• Collaborate with assigned providers to discuss delivery of authorized services for all cases, including complex, high need cases
• Collaborate with Member Services, Quality and NIAC towards ensuring quality of care and promoting placement of members in the appropriate services
• Facilitate and participate in interagency team meetings to discuss behavioral interventions and most appropriate level of care
• Review diagnostic criteria, course of treatment and proposed discharge plans with team and/or physician. Consult with physician on difficult cases and in coordinating physician peer reviews
• Authorize medically necessary services by generating and extending authorizations as clinically indicated
• Participate in grievance hearings to assess current client issues and appropriate level of treatment
• Facilitate and participate in provider meetings, site visits and member interviews at a frequency outlined in the CBH Policy
• Attend various departmental meetings with supervisors and at times, attends in lieu of a supervisor or coordinator
• Complete concurrent reviews for bed-based services authorized for treatment by the PES line.
• Review evaluations recommending preauthorized aftercare services, within established timeframes.

 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: PA Licensed Social Worker (LSW), PA Licensed Professional Counselor (LPC), PA Licensed Marriage and Family Therapist (LMFT), PA 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 CBH.Recruitment@Phila.gov