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, and provider reviews. Authorize treatment meeting ASAM standards for Level of Care and generate denial letters based on physician reviews per state regulations. Collaborate with Physician and Psychologist Advisors to ensure effective treatment authorization and connect members to evidence-based practices at admission, during treatment, and discharge. Facilitate care coordination with system partners to address social determinants and barriers to wellness, while monitoring member length of treatment and addressing placement in less restrictive environments. Document provider quality concerns, conduct quarterly stakeholder meetings, and respond to care coordination correspondence within 24-48 hours. Maintain accurate daily logs, participate in grievance hearings, and assist with training and coverage as assigned. Complete concurrent reviews for bed-based services and prepare for NIAC site visits.
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
- Must be a current Philadelphia resident or become a resident within six months of hire
Desired Qualifications
- Display commitment to member and family driven care
- Principles of resiliency and recovery
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