Clinical Care Manager
$65,600–$67,100 year
On-sitePhiladelphia, Pennsylvania, United States
Job Summary
Conduct utilization management activities including interagency meetings, social determinants interviews, treatment team meetings, case consultations, care coordination, provider meetings, and reviews. Authorize treatment meeting ASAM standards for Level of Care and generate denial letters based on physician reviews. Consult with Physician and Psychologist Advisors to ensure effective treatment authorization. Work directly with members, natural supports, and providers in the community for at least six days per month. Facilitate care coordination with system partners to address social determinants and connect members to community-based services. Complete an average of 8-15 utilization management activities daily while documenting provider quality concerns and maintaining accurate logs. Travel within Philadelphia and surrounding counties, with residency required within six months of hire.
Required Qualifications
- Master's degree in Social Work or related field
- Qualified candidates are required to obtain license within the first 18 months (1.5 years) of employment
- PA Child Abuse Clearance required
- Licensed Social Worker (LSW)
- Licensed Professional Counselor (LPC)
- Licensed Marriage and Family Therapist (LMFT)
- Licensed Clinical Social Worker (LCSW)
- Minimum of 3 years of direct clinical care experience working with adults, children, adolescents and/or their families in behavioral health settings
- Experience in assessment and treatment planning
- Experience in a managed care setting
- Excellent clinical case conceptualization skills
- Meeting facilitation
- Proactive planning
- Customer service
- Familiar with medications
- Excellent verbal and written communication skills
- Ability to use communication skills when communicating with internal and external stakeholders
- Excellent interpersonal and collaboration skills
- Proficient in MS Office, especially with Excel
- Ability to type at least 40 words per minute
- Ability to work independently and as part of a team
- Excellent time management and prioritization skills
- Ability to multi-task
- Compliant with HIPAA regulations
- Must be able to travel within Philadelphia and surrounding counties
- Ability to utilize computers and office equipment to complete daily work responsibilities
- Must be a current Philadelphia resident or become a resident within six months of hire
Desired Qualifications
- Knowledgeable about behavioral health care services, system partners, service continuum and established medical necessity criteria
- Demonstrate an understanding of Evidence-Based Practices (EBPs)
- Ability to connect members to appropriate evidence-based treatment
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