Job Description

Job Title: Licensed Professional Care Manager (Integrated Care)
Job ID: 685928
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: Community Care Behavioral Hlth
Department: Care Management
Location: 339 Sixth Avenue, Pittsburgh PA 15222

Description

Do you currently have an active PA Health/Human Services License? Is your background in behavioral health, clinical care coordination, coaching, and/or case management? Are you experienced in working on a team with minimal supervision? If so, UPMC may have the perfect fit for you!

 

 

UPMC is hiring a full-time Licensed Professional Care Manager to support the Integrated Care team within Community Care Behavioral Health (CCBH). This will be a Monday through Friday daylight position (8:30 a.m. – 5:00 p.m.). Travel within Allegheny county will be required and percentage will vary based on caseload. After successful completion of orientation and the probation period, this role can be considered for work from home, if interested. 

 

 

This position assists Allegheny County members, families, health plans, and providers in facilitating coordination of physical health/behavioral health (PH/BH) care.  The team acts as a liaison to the four physical health plans in Allegheny County and supports the company in meeting the goal of integrated care. The Care Manager position will help to support the team in completing coordination with the physical health plans and behavioral health providers to help address members physical and behavioral health needs. 

 

 

The 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 position will  coordinate with UPMC Health Plan to identify gaps in cares for members , and meet with members in the community to complete assessments and assist in coordination of 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 Manager executes these responsibilities consistent with the applicable Community Care Policies and Procedures.

The Care Manager will also assist the team to provide telephone support to UPMC for You members enrolled in condition management programs.

 

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 to a given population. In addition, a care manager may serve as the care management lead for other members of his/her team.

 

 

Responsibilities:

  • Competently employs motivational strategies that encourage individuals to explore motivation for change, enhance readiness, and develop competence in the use of behavior change skills.

  • Provides coaching in behavioral health programs such as depression, anxiety, and substance use.

  • Provides case management services to address barriers to care.

  • Identifies gaps in service and makes recommendations for changes when indicated to provide the most clinically appropriate services.

  • Assists physical health plans in coordinating care with members behavioral health services for care and treatment planning

  • Attends case conferences, interagency and provider treatment planning meetings for assigned members.

  • Interfaces with and refers members to community based resources and other supportive services as appropriate.

  • Conducts all clinical reviews, service authorization and care coordination (or oversight and supervision) for all assigned members receiving behavioral health services.

  • Performs care coordination for Health Plan members including consultation with health plan colleagues, participation in inter- disciplinary team meetings, and collaboration with providers

  • Consults with appropriate physician advisors as needed for case collaboration and care planning.

  • Coordinates, reviews and maintains daily logs for reporting purposes and for weekly preparation and analysis of trending reports.

  • Demonstrates excellent clinical, written and oral communication skills.

  • 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.

  • 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.

  • Identifies provider issues and recommendations for improvement

  • Implements appropriate clinical interventions to ensure optimal clinical and quality outcomes for members.

  • 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.

  • Maintains an understanding of behavioral health benefits and remains current on covered benefits, limitations, exclusions, and policies and procedures, in regards to services.

  • Maintains contact with and refers members to community based case management services as appropriate.

  • Makes authorization determinations for medically necessary services independently, within the scope of the practice of held licensure.

  • 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.

  • Participates in professional development activities.

  • Possesses excellent clinical skills with sophisticated understanding of the over-all needs of individual members assigned to him or her.

  • Proposes and implements creative solutions to member problems and to achieve a high level of member satisfaction with services.

  • Provides members, providers, and other stakeholders with accurate information concerning behavioral health care benefits and coverage.

  • Receives and responds to complex and crisis calls.

  • Responds to deadlines and has work completed on or before deadline 95% of the time.

  • Utilizes supervision with Coordinator and Associate Clinical Manager regularly.

  • Works as part of a team providing clinical expertise and knowledge to member services and other care management staff

Qualifications

  • Pennsylvania Licensure in health or human services field and masters degree
  • OR licensed RN (BSN preferred)
  • OR Licensed Behavior Specialist (For BHRS levels of care only).
  • 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 in substance use disorders helpful.
  • Supervisory or other leadership experience in behavioral health also preferred

Licensure, Certifications, and Clearances:
Pennsylvania Licensure: RN, LSW, LCSW, LPC, licensed MFT, and/or a licensed PhD (psychologist) Licensed Behavior Specialist (for BHRS levels of care only)

  • Act 33 Child Clearance with Renewal
  • Act 34 Criminal Clearance with Renewal
  • Act 73 FBI Clearance
  • Behavior Specialist or Clinical Social Worker or Licensed Marriage & Family Therapist or Licensed Professional Counselor or Licensed Social Worker or Psychologist or Registered Nurse

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $22.60 to $39.11

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

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