Community Behavioral Health · 1 day ago
Clinical Care Manager - Neurodevelopmental services
Philadelphia, PA, US
Full-time
Onsite
Entry, Mid Level
2+ years expCommunity Behavioral Health is seeking a Clinical Care Manager for Neurodevelopmental Services. The role involves managing utilization review activities, provider management, and ensuring quality treatment for individuals with Autism and other neurodevelopmental disorders.
Health CareHealth Diagnostics
No H1B
U.S. Citizen Only
Responsibilities
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 and extend treatment authorizations when Medical Necessity Criteria is met
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 directly with members, natural supports and providers in the community during 30-75% of work hours or 6-15 days per month
Facilitate care coordination 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 at admission, during treatment, and at discharge
Monitor member’s length of treatment and work collaboratively with providers and other systems to address barriers to member receiving treatment in a less restrictive environment
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 meetings at least 4 times per year
Use data to inform clinical decision-making
Maintain documentation in CBH’s electronic system consistent with agency and industry 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
Attend all meetings as assigned and actively prepare for and participate in supervision and clinical case consultation
Maintain an accurate daily log of work completed
Contribute to projects and other duties as assigned
Manage ABA-Designated Providers within the IBHS Level of Care, consult to teams managing other Levels of Care, as needed or assigned (e.g., Child Acute, RTF)
Complete an average of 8-15 utilization management (UM) activities per day
Complete 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 service authorizations completely and accurately, as assigned
Implement provider management strategies, including review of metrics and key performance indicators, promoting transparent dialogues with all providers with regards to any compliance or outlying performance concerns
Qualification
Required
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
MUST have Pennsylvania License as a Behavior Specialist (BSL)
PA Child Abuse Clearance required
Minimum of 2 years direct clinical experience with children required
Excellent clinical case conceptualization skills
Meeting facilitation
Proactive planning
Customer service
Flexibility and acceptance of change
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 in a fast-paced environment
Commitment to professional ethics code (e.g., BACB, APBA)
Compliant with HIPAA regulations
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
Preferred
BCBA or BCBA-eligible within 18 months (1.5 years) of accepting position preferred
Experience in the provision of ABA services to individuals with Autism spectrum or other neurodevelopmental disorders strongly preferred
Company
Community Behavioral Health
Community Behavioral Health (CBH) provides a variety of behavioral health services to Philadelphia County’s most vulnerable residents.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Alex Gauthier
Chief Financial Officer
Shawna Dandridge
Chief Operating Officer
Recent News
Business Journals
2022-10-13
Company data provided by crunchbase