Coordinator, Care Management - Community and School Based Behavioral Health (CSBBH) Team

UPMC is hiring a full-time Coordinator, Care Management to join CCBH. This role will predominantly work standard daylight hours, Monday through Friday. This role must reside within PA and will require occasional local travel. When not traveling, the Coordinator may work remotely. 

The Coordinator of Care Management (CSBBH Team) has overall responsibility for managing daily operations of the CSBBH Team. 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 and schools, member groups and families, and participates in overall clinical operations management as warranted.

Responsibilities:

• Demonstratres 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 Continuous Quality Improvement 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, providers, primary contractors, and schools 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, and 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, schools and other agency staff as needed to develop and coordinate services.
• Knowledge of Community Resources.
• 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% of the time.
• Assumes daily responsibility for the access and quality of services provided to Community Care members through community-based CSBBH teams. 
• Provides programmatic oversight of community-based CSBBH teams to ensure consistency and fidelity to the model as well as clinical and cost-effectiveness.
• Works closely with the CSBBH team in the continued programmatic refinement of the service.
• Works collaboratively across Community Care departments and external Stakeholders to update processes to ensure that the CSBBH program is as effective and efficient as possible.
• 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 internal CSBBH processes providing input on clinical reviews, service authorization, and care coordination for all Community Care members.
• Proposes and implements creative solutions to problems and achieves a high level of member satisfaction with services.
• Adheres to guiding principles of the organization.
• Acts with the authority of the AVP of Program Implementation & Evaluation, Director of Care Management and Member Services when designated.
• Participates in making presentations to participating providers, state and federal agencies, schools community groups and other interested parties.
• Utilizes supervision effectively. Reports clinical, utilization and outcomes issues to AVP of Program Implementation & Evaluation, Director, 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.