Community Behavioral Health.
IBHS Clinical Care Manager - BCBA
5 days ago
Philadelphia
Job Description The IBHS Clinical Care Manager – BCBA serves as a care manager within CBH’s Neurodevelopmental Services team, responsible for ensuring members with Autism Spectrum and related neurodevelopmental disorders receive timely, evidence-based, and outcome-driven behavioral health services. This role combines utilization and population management, provider engagement, treatment quality monitoring, and cross-system collaboration to promote high-quality, cost-effective care. The CCM-BCBA leverages data and clinical expertise to guide authorization decisions, monitor program quality, and support providers in delivering effective Applied Behavior Analysis (ABA) interventions. Essential Functions: Depending upon your team assignment, some or all of these may apply. • Apply advanced knowledge of behavioral health systems, clinical best practices, and medical necessity criteria to all utilization management activities. Conduct expected number of utilization management activities including, but not limited to, interagency meetings, social determinants interviews, treatment team consultations, and care coordination with providers, members, and families. Authorize, extend, or modify treatment services based on clinical documentation, member need, and established criteria., • 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 hands on in the community with members, natural supports, and providers., • Facilitate care coordination with system partners to address social determinants, barriers to wellness, and additional related member needs, • Demonstrate an understanding of Evidence-Based Practices (EBPs) and connect members to appropriate evidence-based treatment at admission, during treatment, and at discharge., • Monitor members’ progress and treatment duration, promoting the least restrictive and most clinically appropriate service environments., • 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., • Conduct provider meetings at least 4 times per year., • Participate in supervision, case consultations, and team meetings;, • Maintain thorough, timely, and accurate documentation in CBH’s electronic system consistent with regulatory and organizational 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., • Maintain an accurate daily log of work completed., • Contribute to projects and other duties as assigned. Team Specific Responsibilities: • Manage ABA Providers within the IBHS Level of Care, • Provide consultation to teams across other levels of care (inpatient, residential treatment) around ABA treatment planning and service delivery for youth with ASD and other neurodevelopmental disabilities., • Complete utilization management (UM) activities per day in accordance with current productivity standards, ensuring clinical accuracy and timely completion., • Complete thorough and accurate reviews of service authorization requests, including review of Written Orders, Physician consultation per Review Guidelines, provider notification, referral submission (if required), denial letter (if required), authorization generation (if required), and log of review., • Participate in at least 8 inter-agency or inter-disciplinary team meetings per month for members being recommended for, or receiving, ABA Services, • Ensure collaboration and continuity of care for members with multiple services or in multiple child-serving systems., • Facilitate collaboration with community-based treatment team for members experiencing a crisis., • Conduct crisis consultations for members receiving ABA, as needed, including supporting member through access to higher levels of care and return to community-based services., • Conduct progress monitoring reviews for members in need of intensive care management, or as indicated by provider outlier performance., • Complete clinical audit tools or chart reviews, as clinically indicated., • Review and report provider metrics and key performance indicators (KPIs) to identify strengths, address barriers, and promote best practices., • Collaborate with providers to address outlier trends and develop corrective action or quality improvement plans., • Support new provider onboarding and continuous learning for internal and external stakeholders., • Education: Master’s degree in Applied Behavior Analysis, Psychology, or Special Education preferred. Master’s degree in a closely related field (e.g., Social Work, Counseling) with at least 18 credits in graduate-level coursework in ABA accepted., • License/Certification: BCBA required with License as a Behavior Specialist (BSL), LSW, LCSW, LPC or LMFT. PA Child Abuse Clearance required., • Relevant Work Experience: Minimum of 2 years direct clinical experience with children required,, • Excellent clinical case conceptualization skills, • Advanced clinical case conceptualization and analytical skills., • Proficient in MS Office, especially with Excel, and able to type at least 40 words per minute, • Strong communication and facilitation abilities with both internal and external stakeholders., • Excellent time management, organization and adaptability in a fast-paced environment., • Commitment to trauma informed and ethical practice, • Understanding of Pennsylvania IBHS regulations and documentation standards, • Strong customer service skills, • Excellent verbal and written communication skills Excellent interpersonal and collaboration skills, • Ability to work independently and as part of a team, • Commitment to professional ethics code (e.g., BACB, APBA), • Compliant with HIPAA regulations Applications will be considered on a rolling basis and decisions will be made as soon as appropriate candidates are identified 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. U.S. Authorization Requirement: • 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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