Substance Use Disorder Management Specialist

Pmhcc,-Inc.-1; Philadelphia (Philadelphia County); On-site; USD 54,000 - 66,000; Full time

Job summary

PMHCC, Inc. in Philadelphia is seeking a Substance Use Disorder Management Specialist to lead utilization management and care coordination, ensuring access to medically necessary behavioral health services.

The role requires strong clinical skills, collaboration with partners, and adherence to HIPAA. Salary listed is $60,000 annually, with duties spanning provider management and quality monitoring.

Qualifications

• Bachelor’s or Master’s degree with relevant SUD experience.
• Strong clinical case conceptualization and advocacy.
• Knowledge of HIPAA regulations.
• Ability to coordinate care and use ASAM Criteria.

Responsibilities

• Authorize and reauthorize treatment using ASAM Criteria.
• Coordinate care with system partners to address social determinants and member needs.
• Liaise with provider agencies as primary contact.
• Authorize continuation or adjust levels of care as needed.
• Perform on-site utilization reviews and required paperwork.
• Monitor eligibility via PROMISe & e-CIS systems.
• Maintain documentation in electronic systems.
• Train and support new staff as requested.

Skills

Clinical case conceptualization

Advocacy & listening

Meeting facilitation

Psychiatric/medical knowledge

Verbal & written communication

Interpersonal skills

MS Office (Excel)

Independent & team work

Time management

HIPAA compliance

Education

Bachelor’s degree + SUD experience

Bachelor’s degree + 5 years SUD

Master’s degree + 2 years SUD

Master’s degree + 3 years SUD

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Substance Use Disorder Management Specialist

Regular Full-Time Philadelphia, PA, US

30+ days ago Requisition ID: 3090

Salary: $60,000.00 Annually

Position Summary:

The Clinical Service Manager is responsible for utilization management by conducting utilization review activities, population management, cross-system consultation, provider management and treatment quality monitoring. The Clinical Service Manager must utilize clinical knowledge of best practices and evidence-based treatments to ensure BHSI members receive timely access to quality, medically necessary behavioral health services.

Duties and Responsibilities:

Authorize and reauthorize treatment utilizing ASAM Criteria.

• 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.
• Carries a caseload of provider agencies and acts as the liaison and primary contact to those agencies.
• Authorizes and reauthorizes the continuation of treatment or recommends and facilitates necessary changes in the levels of care.
• Performs on-site utilization review activities as needed which may include, but are not limited to, the review of client charts, documentation of treatment services, completion of required paperwork, confirmation of attempt to establish M.A. eligibility.
• Performs telephonic screenings as required and clinical dispositions as needed.
• Monitors program eligibility of active patients via the Department of Welfare’s PROMISe & e-CIS systems. Appropriately manage cases based on eligibility.
• Ensures all required client paperwork is received and complete.
• Maintain documentation in BHSI’s electronic system consistent with agency and industry standards.
• 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.
• Display clinical integrity, advocacy and commitment to member and family driven care and principles of resiliency and recovery.
• Other duties as assigned.

Skills Required:

• Excellent clinical case conceptualization skills
• Maintain high levels of advocacy. Possess the ability to actively listen and work to resolve grievances expressed by the provider network and community members, while exercising care and compassion.
• Proactive planning and meeting facilitation
• Familiar with psychiatric and medical conditions and concurrent medication usage
• 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 and Confidentiality regulations

Education and Experience:

Bachelor’s degree in related field with 3 years of relevant work experience in SUD; bachelor’s degree and 5 years of relevant work experience in SUD; master’s degree in related field with 2 years of relevant work experience in SUD; or master’s degree with 3 years of relevant work experience in SUD.

Equal Opportunity Employment:

PMHCC, Inc. is committed to equal opportunity. It is our policy to support equal employment for all employees and applicants without regard to race, religion, color, sex, sexual preferences, age, national origin, disability, behavioral health status, military status or any other characteristic protected by law.

Americans with Disabilities Act:

Employees as well as applicants who are currently, or become disabled, must be able to perform the functions of the job with either reasonable accommodation or unaided. PMHCC, Inc. will examine reasonable accommodations on a case-by-case basis in accordance with the law.