Clinical Care Manager - Integrated Care (CBCM)
hace 27 días
Philadelphia
Job Description The Clinical Care Manager (CCM) is responsible for delivering integrated, person - centered care management to individuals with complex behavioral and physical health needs. The CCM facilitates care coordination across multiple systems, ensures timely utilization management (UM) activities, and promotes collaboration between providers, members, and support systems to improve health outcomes. Clinical Care Managers are assigned to specific teams based on population needs and service settings, with some responsibilities tailored to those contexts. Essential Functions • Deliver longitudinal, integrated care management for assigned members across levels of care and systems., • Apply knowledge of behavioral health systems, service continuums, and medical necessity criteria in all clinical and administrative activities., • Collaborate with members, natural supports, and providers in homes, communities, hospitals, ASAM Rehabs, and virtual environments., • Address social determinants of health and barriers to care using an intergenerational and cross-systems approach., • Ensure Providers are using Evidence-based Practices in treatment planning for members., • Use evidence-based practices to connect members to appropriate behavioral health and physical health treatments. Utilization Management (UM): • Complete UM activities including interagency meetings, case consultations, provider communications, care coordination, treatment plan reviews, social determinants assessments, and treatment linkage., • Authorize services when medical necessity criteria are met; consult with Clinical Leadership, Physician or Psychologist Advisors as needed., • Generate denial letters when appropriate, in accordance with regulations and CBH policy., • Monitor length of stay and work with providers to ensure timely transitions to less restrictive levels of care. Collaboration & Stakeholder Engagement: • Facilitate cross-system care planning with behavioral and physical health providers, education, child welfare, juvenile justice, and other entities., • Conduct provider and stakeholder meetings, typically quarterly, to enhance collaboration and problem-solve care barriers., • Coordinate with CBH internal departments to promote continuity, quality of care, and appropriate service placement., • Collaborate with Providers and members when appropriate to get consents and facilitate the creation of an Integrated Care Plan (ICP)., • Coordinate with providers where and when appropriate to ensure that members ICP is shared with all their behavioral providers. Documentation & Compliance: • Maintain thorough and timely documentation in CBH’s electronic systems, in alignment with organizational and regulatory standards., • Report and document provider quality concerns per policy., • Use data to guide clinical decision-making and monitor care outcomes., • Respond to care coordination inquiries within 24–48 hours or sooner, as clinically indicated., • Maintain an accurate daily activity log and contribute to audits or site visits (e.g., NIAC) as needed. Teamwork & Professional Development: • Actively engage in individual and group supervision, case consultations, team meetings, and ongoing trainings., • Support team functions by assisting in onboarding new staff, covering team responsibilities during absences, and participating in special projects., • Ensure high-quality customer service and embody CBH values including member and family-driven care, resiliency, and recovery., • Demonstrate flexibility and adaptability to support the evolving needs of the team and population served. Team - Specific Functions Community Based Care Management Team • Complete 8 -15 UM activities per day., • Conduct care coordination to support collaboration with physical health and system partners., • Work directly in the community with members and providers., • Engage members offsite in physical health or community based organizations 2-3 days per week, • Complete SDOH and other evidence based risk assessment tools Position Qualifications Education: • PA Child Abuse Clearance required., • Required to obtain licensure within the first 18 months (1.5 years) of employment if not already licensed., • Minimum of 3 years of direct clinical care experience working with adults, children, adolescents, and/or their families in behavioral health settings., • Experience in assessment and treatment planning required., • Experience in managed care or utilization management preferred., • Prior experience in community-based and clinic settings strongly preferred., • Emphasis on direct engagement with members, families, and providers in community settings. Core Skills & Competencies: • Excellent clinical case conceptualization and treatment planning skills., • Strong communication skills, both verbal and written, with ability to collaborate across systems., • Excellent interpersonal and collaboration skills., • Ability to facilitate care team and interagency meetings., • Familiarity with medications and behavioral health terminology., • Strong customer service orientation., • Proactive planning and organizational skills., • Proficient in Microsoft Office (especially Excel); ability to type 40+ words per minute., • Strong time management skills; ability to multi-task and work independently or as part of a team., • Compliant with HIPAA and applicable clinical documentation standards., • Skills in conflict resolution, engagement, and clinical supervision/oversight of care coordination are essential. Work Conditions (including travel, overtime required, physical requirements and occupational exposure): • Must be able to travel frequently In Philadelphia and surrounding counties., • Out-of-state travel may be required occasionally., • Some evenings and weekends will be required to meet the needs of FSPs, YSPs, and youth/families served., • 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 is routinely needed., • Must be able to adapt to continuous changes/demands of the job. We Offer: • Family Planning, Fertility, Adoption Benefits, • Flexible work hours and work from home opportunities, • 403B Retirement Plan, • PTO Days/Sick Days/Wellness Days, • Education Assistance, • Wellness Program, • Employee Assistance Program, • Health, Dental, Vision Insurance, • Medical, Prescription Drug Insurance, • Commuter Benefits, • Flexible Spending Applications will be considered on a rolling basis and decisions will be made as soon as appropriate candidates are identified Philadelphia Residency Requirement: • CBH does not provide sponsorship for applicants requiring future work authorization. All candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future. 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. 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.
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