Clinical Care Management Specialist - FOCUS

Job Description

Job Description

The Clinical Care Manager (CCM) Specialist- Children’s Complex Care is part of a specialized team, responsible for providing high intensity care management, that works collaboratively and directly with members and providers to ensure effective, holistic, member-centric care.

The CCM Specialist will also be responsible for utilization management by conducting utilization review activities, population management, cross-system consultation, and treatment quality monitoring. 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, CCM Specialists consult with CBH Physician and Psychologist Advisors to ensure the most effective treatment for the CBH member is being authorized.

As the CCM Specialist assists members and their families in learning to accomplish goals they have identified by exploring the strengths and culture around each need they have. The CCM Specialist facilitates monthly interagency/family planning meetings to assist the member and their family in planning around and working towards meeting their needs.

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.
• Create and maintain a team of system partners and natural supports for each member and their family.
• Complete an effective Crisis Prevention Plan in collaboration with each assigned member and their team
• Be knowledgeable about behavioral health care services, system partners, service continuum and established medical necessity criteria and apply that knowledge in all work activities.
• Attend up to 3 hours of group or individual skills-based coaching/supervision per week
• 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 the highest quality of customer service when interacting with members, providers, and other stakeholders.
• Display commitment to member/family-driven care and principles of resiliency and recovery.
• Contribute to projects and other duties as assigned.

Team Specific Responsibilities:

• Facilitate monthly interagency Planning/Family Meetings (includes youth/family participation) for a caseload of approximately 40 members and their families.
• Write, revise and distribute individualized Plans and documents to member’s teams monthly.
• Ensure that the principles and steps of the Family Driven Care Coordination model process are delivered with the highest possible fidelity.
• Support evidence-based intensive care management interventions directly to members in the community.
• Maintain a care management caseload of approximately 40 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
• Participate in and complete training and credentialing in the Youth and Family Training Institute (YFTI) of care management.
• Maintain a flexible schedule, which may include some evenings or occasional weekends, in order to accommodate the scheduling needs of assigned members and their families

Position Requirements:

• Education: Master’s degree in Social Work or related field
• Clinical Licensure: Qualified candidates are required to obtain license within the first 9 - 18 months 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)
• Must obtain High-Fidelity Wraparound Facilitator credential within 1 year of hire.
• 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 regulations

Philadelphia Residency Requirement:

• The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.

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 View email address on ziprecruiter.com