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OR Manager

Community Behavioral Health

This is a Full-time position in Philadelphia, PA posted October 26, 2021.

CBH continues to expand its clinical management department to provide more comprehensive and integrative care to our members and assist with mitigating social determinants of health (SDOH).

CBH offers our employees:

  • Competitive compensation
  • Opportunities to grow
  • Relocation assistance available
  • 90%+ employer paid health insurance premiums with $0 deductibles
  • 403b plan with high match contribution
  • Generous vacation, sick, personal and holiday paid time off tuition reimbursement
  • Wellness programs

Position Overview:

The Clinical Care Manager, CBCM Integrated Care 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 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. The Clinical Care Manager will work to enhance physical and behavioral health care coordination and assist with mitigating social determinants of health (SDOH).

Essential Functions:

  • 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.
  • Complete expected number of UM activities per day/shift as specified under team specified under team specific responsibilities in 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.
  • Work directly with members, natural supports and providers in the community.
  • 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.
  • 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.
  • Conduct provider and/or stakeholder meetings at least quarterly.
  • 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.
  • Work collaboratively with the on-site inter-disciplinary team.
  • 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:

  • Complete an average of 8-15 UM activities per day.
  • Facilitate care coordination with external stakeholders.
  • Complete integrated care plans to promote collaboration with physical health providers and system partners.

Position Requirements:

  • Education: Master’s degree in Social Work or related field or Registered Nurse
  • License/Certification: License eligible and willing/able to obtain licensure within the first year of employment; PA Child Abuse Clearance and proof of COVID vaccination required
  • Preferred Licensure: Licensed Social Worker (LSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW)
  • Community Based/Clinic Setting experience.
  • Strong communication skills
  • 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
  • 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 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.

Equal Employment Opportunity: CBH provides equal employment opportunities to all qualified individuals without regard to race, creed, color, religion, national origin, age, sex, marital status, gender identity, sexual orientation, individual genetic information or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function.

Americans with Disabilities Act: Applicants as well as employees who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. CBH will determine reasonable accommodation on a case-by-case basis in accordance with applicable law.

This job profile reflects management’s assignment of current duties, responsibilities, and essential functions; it does not prescribe all or restrict the tasks that may be assigned now, or in the future, relevant to the responsibilities for this position. Community Behavioral Health (CBH) may change the specific job duties with or without prior notice based on the needs of the organization.