Community Behavioral Health.
Clinical Care Management Specialist FOCUS
5 days ago
Philadelphia
Job Description The Clinical Care Manager Specialist-Children’s Complex Care is part of a specialized team responsible for providing intermediate care management by working collaboratively with members and providers across all children’s levels of care, to ensure effective, and holistic member-centered care. The Clinical Care Management 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 Specialist 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. As a member of CBH’s Children’s Complex Care team, training in FOCUS, an evidence-informed care management intervention will be provided. As a member of the Children’s Complex Care team, you will have an opportunity to apply your understanding of behavioral health and your cultural humility to work collaboratively with CBH members, and their families, to screen and assess their unique needs across multiple life domains, and direct care coordination interventions accordingly. The Clinical Care Manager Specialist will be responsible for monitoring the provision of FOCUS care coordination activities by a FOCUS provider, as well as conducting utilization management activities across all levels of care for assigned members for the duration of their enrollment in the FOCUS program. Essential Functions: • Work directly with members and their families, during intake period, including meeting in members’ homes., • 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, within 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., • Demonstrate an understanding of Evidence-Based Practices (EBPs) and connect members to appropriate evidence-based treatment, • 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., • 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., • 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., • Display commitment to member and family driven care and principles of resiliency and recovery., • Contribute to projects and other duties as assigned. Team Specific Responsibilities: • Conduct a 30-day intake and assessment period for all newly enrolled FOCUS members, which includes meeting with members in their homes, at least weekly, during their initial 30 days in FOCUS, • Collaborate with members and their families at their initial intake visit to develop an initial Crisis and Safety Plan unique to the member, their needs, and their culture, • Complete assessments with members and their families, including a level of care assessment and a Social Determinants of Health screening, to ensure right-sized matching to a care coordination service, • Complete all assigned trainings, including, but not limited to, all FOCUS trainings, and training for all required assessments and screenings, • Ensure FOCUS case managers use an inter-generational approach, partnering will all involved systems and providers, to address social determinants, barriers to wellness, and other needs of members, including connection to appropriate community-based services., • Monitor the quality of FOCUS care coordination by their FOCUS case manager, by collecting and documenting monthly plans of care, and meeting with the assigned FOCUS case management team to discuss members’ care at least monthly, • Maintain a care management caseload of approximately 40 members (or as otherwise directed)., • Direct provision of FOCUS care coordination provided by FOCUS case managers, across external entities including behavioral and physical health providers, Child Welfare, Juvenile Justice, School district of Philadelphia, as well as any other providers or systems involved with assigned members’ families., • Address member/caregiver engagement in treatment by reporting or addressing any reported/observed quality concerns, resolving communication barriers between member (and/or caregiver) and providers, assisting member/caregiver with mediation issues/barriers, assisting with any clarification/prioritizing issues, increase positive collaboration with providers and other supports., • Facilitate longitudinal care management of all assigned members, • 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: Licensed Social Worker (LSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW), • 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, • Conflict and crisis management, • Reliable, accountable, resourceful, curious, flexible and creative, • Empathetic (Accepting/non-judgmental), • 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 regularly 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., • 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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