UPMC Community Care Behavioral Health is hiring a Licensed Professional Care Manager for Allegheny County. This role will work in a hybrid structure with some time spent working remotely as well as travelling throughout the community. Occasional presence in the office in downtown Pittsburgh may be needed at times.
Mileage reimbursement is provided at the IRS rate. A Care Manager is responsible for assisting members identified at risk for recidivism, discontinuous care, or as members of priority or special needs populations who present with complex needs for coordination of their behavioral health services with other aspects of their care. The care manager is responsible for assisting these assigned members to care at all levels of the continuum, and for providing any and all required pre-certification, continued stay and/or discharge reviews; service authorization, and care coordination as needed.
The Care Manages executes these responsibilities consistent with the applicable Community Care Policies and Procedures. A care manager represents the organization to providers, member groups and families, and participates in the overall administration of clinical operations as warranted. A care manager is expected to bring a level of clinical leadership to the care management department.
These care managers are specifically chosen based upon a targeted area of practice, supported by education, training, and experience, with expertise in the delivery of behavioral health care. In addition, a care manager may serve as the care management lead for other members of his/her team. Title and salary will be determined based upon education and care manager experience for Sr.
Professional Care Manager within Community Care Behavioral Health
Makes authorization determinations for medically necessary services independently, within the scope of the practice of held licensure. Demonstrates knowledge of clinical treatment, case management and community resources. Encourages coordination of care with primary care physician and other service providers integral to the member's life.
Monitors and evaluates effectiveness and outcome of treatment and service plans and recommends, modifications as necessary to provide optimal clinically appropriate services with a goal of maintenance in the community at the least restrictive level of care. Assists assigned members with smooth transition when moving into or out of the county. Demonstrates excellent clinical, written and oral communication skills.
Responds to deadlines and has work completed on or before deadline 95% of the time. Develops specific outreach plans for assigned members who do not maintain regular contact with their behavioral health provider as recommended contributing to frequent crises, recidivism, and interfering with maximum benefit from available care. Implements appropriate clinical interventions to ensure optimal clinical and quality outcomes for members.
Works with Member Services, Network Management and Quality Management staff to assure that systematic revisions to improve services are developed and implemented. Assists with coordinating information and making presentations to participating providers, state and federal agencies, community groups and other interested parties. Identifies provider issues and recommendations for improvement.
Assumes responsibility for a designated client case load across the continuum. Provides members, providers, and other stakeholders with accurate information concerning behavioral health care benefits and coverage. Facilitates linkages for members and families between primary care and behavioral health providers and other social service or provider agencies as needed to develop and coordinate service plans.
Maintains contact with and refers members to community-based case management services as appropriate. Possesses excellent clinical skills with sophisticated understanding of the over-all needs of individual members assigned to him or her. Consults with appropriate physician advisors as needed for case collaboration and care planning.
Attends case conferences, interagency and provider treatment planning meetings for assigned members. Participates in professional development activities. Works as part of a team providing clinical expertise and knowledge to member services and other care management staff.
Supervises collection of information regarding the delivery and outcomes of services to members, and uses that information to recommend modifications to plan policies and procedures which improve the delivery of services to members. Coordinates, reviews and maintains daily logs for reporting purposes and for weekly preparation and analysis of trending reports. Collaborates with providers and others in order to obtain initial assessment, treatment planning and aftercare planning for members.
Conducts all clinical reviews, service authorization and care coordination (or oversight and supervision) for all assigned members receiving behavioral health services. Independently problem solves based on advanced-level knowledge of the service delivery system, the provider network, member services policies, members' rights and responsibilities, and the operating practices of the organization. Proposes and implements creative solutions to member problems and to achieve a high level of member satisfaction with services.
Maintains an understanding of behavioral health benefits and remains current on covered benefits, limitations, exclusions, and policies and procedures, in regards to services. Utilizes supervision with medical director and clinical manager regularly. Participates in CQI activities and provider training.
Works with members and providers to customize services to best meet members' needs within the scope of Community Care's obligations to its members. Receives and responds to complex and crisis calls. Responds to member and provider complaints according to Community Care's policies and procedures.
Pennsylvania Licensure in health or human services field and master's degree OR licensed RN (BSN preferred) OR Licensed Behavior Specialist (For IBHS levels of care only). Preference will be given to RN, LSW, LCSW, LPC, licensed MFT, or licensed PhD (psychologist). Minimum of three years of relevant clinical experience.
Experience in managed care strongly preferred. General knowledge of best practices in behavioral health, emphasizing work with special needs or priority populations and in public sector systems. Certification as a Certified Addiction Counselor (CAC) or Certified Alcohol and Drug Counselor (CADC) is helpful.
Supervisory or other leadership experience in behavioral health also preferred. Licensure, Certifications, and Clearances: A current and unrestricted Pennsylvania
RN, LSW, LCSW, LPC, licensed MFT, or a licensed PhD (psychologist). Licensed Behavior Specialist (for IBHS levels of care only). Automotive Insurance Behavior Specialist OR Clinical Social Worker (CSW) OR Licensed Marriage & Family Therapist OR Licensed Professional Counselor (LPC) OR Licensed Social Worker (LSW) OR Psychologist OR Registered Nurse (RN) Driver's License Act 33 with renewal Act 34 with renewal Act 73 FBI Clearance with renewal *Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state.
Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state. UPMC is an Equal Opportunity Employer/Disability/Veteran