Clinical Care Management Specialist
Company: Community Behavioral Health.
Posted on: June 25, 2022
The Clinical Care Manager Specialist 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. This position
requires on-site presence at Family Court. 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
- 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
- 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
- Conduct provider and/or stakeholder meetings at least
- 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
- 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
- Work directly with members and system partners in the courtroom
during approximately 75% of work hours.
- Complete an average of 13-16 UM activities per day including:
participating in court hearings, precertification, telephonic
reviews, evaluation reviews, interagency meetings, coordinating
care, writing case notes, and completing denial letters.
- Be knowledgeable about child welfare and juvenile justice
systems and apply that knowledge in all work activities.
- Complete case consultations with probation officers, attorneys,
Department of Human Services, Community Umbrella Agencies, and
- Accommodate internal and external court observers.
- Review evaluations completed through the Family Court Clinical
Evaluation Unit for substance use treatment and authorize as
medically necessary. Position Requirements:
- Education: Master's degree in Social Work or related field or
- License/Certification: License eligible and willing/able to
obtain licensure within the first year of employment; PA Child
Abuse Clearance required
- Preferred 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
- 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
- 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
- Compliant with HIPAA regulations Equal Employment Opportunity:
CBH provides equal employment opportunities to all qualified
individuals without regard to race, creed, color, religion,
national origin, age, sex, marital status, gender identity, sexual
orientation, individual genetic information or non-disqualifying
physical or mental handicap or disability in each aspect of the
human resources function.Americans with Disabilities Act:
Applicants as well as employees who are or become disabled must be
able to perform the essential job functions either unaided or with
reasonable accommodation. CBH will determine reasonable
accommodation on a case-by-case basis in accordance with applicable
Keywords: Community Behavioral Health., Philadelphia , Clinical Care Management Specialist, Executive , Philadelphia, Pennsylvania
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