Clinical Care Management Specialist FOCUS
Company: Community Behavioral Health.
Location: Philadelphia
Posted on: November 7, 2024
Job Description:
The Clinical Care Manager (CCM) Specialist - Complex Care is
part of a specialized team responsible for providing intermediate
or high intensity care management that works collaboratively and
directly with members and providers to ensure effective, holistic,
member centric care. As a member of CBH's Complex Care team,
training and certification in evidence-informed care management
interventions may be provided as well as supervision to support
those looking to obtain their license. The CCM Specialist will also
be responsible for utilization management by conducting utilization
review activities, population management, cross-system
consultation, and treatment quality monitoring. 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
competence to work collaboratively with CBH members, their
caregivers, their supports, other professionals, and community
partners to screen/assess, and develop individualized,
family-anchored, comprehensive, and strength-based plans of care.
The CCM 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.
*This position is a hybrid role with an expectation to go into the
members' homes as well as on sites in Philadelphia area; with two
days in the office at 801 Market Street. Essential Functions:
- Work directly with members, natural supports and providers in
the community, including in members' homes.
- Facilitate care coordination. Using an inter-generational
approach, with system partners to address social determinants,
barriers to wellness, and other needs of members, including
connection to appropriate community-based services.
- Facilitate family Plan of Care meetings for assigned members
monthly.
- 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:
- Facilitate monthly Plan of Care meetings for the families of
each assigned member monthly.
- Provide evidence-informed intermediate care management
interventions directly to members in the community.
- Maintain a care management caseload of approximately 18 members
(or as otherwise directed).
- Facilitate care coordination with external entities including
behavioral and physical health providers, Child Welfare, Juvenile
Justice, School district of Philadelphia, and Targeted Case
Management (TCM), 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.
- Complete UM activities as assigned and within required
timeframe Position Requirements:
- Education: Master's degree in Social Work or related field
- License/Certification: Willing/able to obtain licensure within
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
care setting Skills:
- 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 regulationsCore Competencies:
- Teamwork and Collaboration: Build and sustain relationships
with co-workers and stakeholders and support efforts and
deliverables. Encourage unity and help remove barriers to
productivity and success.
- Respect: Treat each other and our members and stakeholders with
respect and sensitivity, recognizing the importance of
diversity.
- Member Centric: Focus on the needs of our members by providing
value-added services, promoting strong relationships and going
beyond basic expectations to achieve the best possible
outcomes.
- Honesty and Integrity: Be open and honest in all we do.
Maintain the highest level of integrity at all times.
- Commitment to Service Excellence: Challenge ourselves to be
forward-thinking and committed to providing total member and
stakeholder satisfaction, first-in-class service and high quality,
innovative programs.
- Compassion and Empathy: Demonstrate a deep appreciation for
another's situation and point of view. Pay attention to emotional
cues, listen effectively and show an exceptional level of caring
about each person's perspectives and circumstances.
- Problem Solving: Build and implement logical solutions to
resolving challenges/issues by using individual knowledge and
experience while taking resources, constraints and CBH values into
consideration.
- Initiative and Self-Directed: Proactively manage time and
resources in a way that ensures that all work is done in the most
efficient manner while identifying and implementing initiatives
without interventions from co-workers, supervisors or
stakeholders.
- Flexibility and Adaptability: Adjust approaches and behaviors
in order to meet the constantly changing environment head-on and
accomplish CBH and individual goals. Strive to adapt to, accept and
embrace change within areas of responsibility.
- Communication: Effectively and appropriately share thoughts,
ideas and information - both written and oral. Respectfully listen
to co-workers and stakeholders to gain a full understanding of
issues/situations. 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.
- Must be able to adapt to continuous changes/demands of the job.
U.S. Authorization 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.Equal Employment Opportunity:
- 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.Requesting An Accommodation:
- 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.
- If you would like to be considered for employment opportunities
with CBH and have accommodation needs for a disability or religious
observance, please send us an email at
CBH.Recruitment@phila.gov
PI05a6b2d3a53c-37248-35706140
Keywords: Community Behavioral Health., Lancaster , Clinical Care Management Specialist FOCUS, Executive , Philadelphia, Pennsylvania
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