Clinical Care Manager CBCM

Community Behavioral Health; Philadelphia (Philadelphia County); On-site; USD 50,000 - 80,000; Full time

Job summary

An established industry player is seeking a Clinical Care Manager to enhance behavioral health services. This role involves utilizing clinical knowledge to ensure members receive quality care, conducting utilization management, and collaborating with various stakeholders. Ideal candidates will have a Master's degree in Social Work and strong communication skills, with a commitment to member-driven care. Join a team dedicated to improving health outcomes and making a positive impact in the community. If you are passionate about behavioral health and eager to contribute to a supportive environment, this opportunity is perfect for you.

Qualifications

• Master’s degree in Social Work or related field required.
• Must obtain clinical license within 18 months of employment.

Responsibilities

• Conduct utilization management activities and care coordination.
• Collaborate with providers and stakeholders for quality care.
• Document and respond to coordination correspondence promptly.

Skills

Clinical case conceptualization

Proactive planning

Customer service orientation

Communication skills

MS Office proficiency

Time management

HIPAA compliance

Education

Master’s degree in Social Work

Clinical license (LSW, LPC, LMFT, LCSW)

Tools

MS Office

Job description

Join to apply for the Clinical Care Manager CBCM role at Community Behavioral Health.

The Clinical Care Manager is responsible for utilization management activities, including review, population management, cross-system consultation, provider management, and treatment quality monitoring. The role requires applying clinical knowledge of best practices and evidence-based treatments to ensure CBH members receive timely, quality, and medically necessary behavioral health services. When indicated, Clinical Care Managers consult with CBH Physician and Psychologist Advisors to ensure effective treatment authorization. The role also involves enhancing physical and behavioral health care coordination and addressing social determinants of health (SDOH).

Essential Functions

1. Maintain knowledge of behavioral health services, system partners, service continuum, and medical necessity criteria, applying this knowledge in all activities.
2. Conduct utilization management activities such as interagency meetings, social determinants interviews, treatment planning, case consultations, and care coordination.
3. Complete the expected number of UM activities daily as specified in team responsibilities within established timeframes.
4. Authorize treatment when Medical Necessity Criteria are met.
5. Consult with Physician Advisor, Psychologist Advisor, and/or Clinical Leadership as appropriate.
6. Generate denial letters based on reviews and in accordance with regulations.
7. Work directly with members, supports, and community providers.
8. Facilitate care coordination, addressing social determinants and connecting members to community services.
9. Understand and connect members to Evidence-Based Practices (EBPs).
10. Collaborate with CBH departments to ensure quality care and appropriate service placement.
11. Document provider quality concerns per CBH policies.
12. Conduct provider/stakeholder meetings quarterly.
13. Use data to inform clinical decisions.
14. Maintain documentation in CBH’s electronic system according to standards.
15. Respond to coordination correspondence within 24-48 hours.
16. Participate actively in team meetings, supervision, and clinical consultations.
17. Provide high-quality customer service to members, providers, and stakeholders.
18. Commit to member and family-driven care, resiliency, and recovery principles.
19. Contribute to projects and other duties as assigned.

Team Specific Responsibilities

1. Complete 8-15 UM activities daily.
2. Facilitate care coordination with external stakeholders.
3. Create integrated care plans to promote collaboration with physical health providers and partners.

Position Requirements

• Master’s degree in Social Work or related field.
• Must obtain clinical license within 18 months of employment; PA Child Abuse Clearance required.
• Required Licensure: LSW, LPC, LMFT, LCSW.
• Experience in community-based or clinical settings.
• Strong communication skills.
• Minimum 3 years of clinical work with diverse populations and experience in assessment and treatment planning; managed care experience preferred.

Skills

• Strong clinical case conceptualization and facilitation skills.
• Proactive planning and customer service orientation.
• Knowledge of medications.
• Excellent verbal and written communication, interpersonal, and collaboration skills.
• Proficient in MS Office, especially Excel, with typing speed of at least 40 WPM.
• Ability to work independently and within a team.
• Excellent time management and multi-tasking abilities.
• HIPAA compliance.

Residency Requirement

Must be a current Philadelphia resident or become one within six months of hire.

EEO & Accommodation

CBH promotes diversity, inclusion, and equal opportunity. Accommodations for disabilities or religious observance are available; contact [e-mail] for considerations.