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Coordinator, Care Management - Children's Services

  • Job ID: 155325663
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Community Care Behavioral Health
  • Department: Care Mgmt Admin Sat CMP
  • Location: 300 Community Drive, Tobyhanna PA 18466
  • Union Position: No
  • Salary Range: $32.01 to $54.03 / hour

Description

UPMC Community Care Behavioral Health is seeking a full-time Coordinator of Care Management to support the Tobyhanna, PA office and surrounding counties!

The Coordinator of Care Management will work standard hours, Monday through Friday, in a hybrid work structure! This role will have a combination of in-office, work-from-home, and some provider site days to support the Carbon-Monroe-Pike area. 

The Coordinator has overall responsibility for managing daily operations of the office, as well as the responsibility for the clinical administrative supervision and management of the specified care management teams. This role ensures the provision of clinical services consistent with all applicable policies and procedures, and represents the organization to providers, member groups, and families. In addition to participating in overall clinical operations management, as warranted, the Coordinator of Care Management will also have their own caseload to further support the team.


Responsibilities:

  • Demonstrates leadership.
  • Responsible for directly assisting daily operations of the unit when scheduled staff are unable to perform their duties.
  • Maintains an up-to-date understanding of benefits, in-plan services, and the regulatory environment and remains current on covered benefits, limitations, exclusions, and policies and procedures.
  • Coordinates, reviews, and maintains data for reporting purposes and for weekly preparation and analysis of trending reports.
  • Participates in CQI activities and provider training, and participates in professional development activities.
  • Coordinates the complaint and grievance process for members.
  • Works with Network Management and Quality Management staff to ensure that systematic revisions to improve services are developed and implemented.
  • Works with internal network staff and providers to identify opportunities for the development of alternative or non-traditional services to best meet members' needs.
  • Works as part of the management team in collaboration with Member Services, Network Management, and Quality Management departments to ensure that systematic revisions to improve services are developed and implemented.
  • Attends case conferences and interagency and provider treatment planning meetings for members when the assigned care managers are unavailable or when an assigned care manager requires clinical administrative support.
  • Meets with members and families, primary care and behavioral health providers, and other agency staff as needed to develop and coordinate services.
  • Knowledge of Community Resources.
  • Works closely with the director in the continued development of the care management department.
  • Demonstrates excellent clinical, written, and oral communication skills.
  • Monitors daily activity to ensure that services of the department are provided within standards.
  • Provides accurate information concerning benefits and coverage to staff or others, as required.
  • Receives and responds to complex calls to assist in their resolution.
  • Responsiveness to deadlines and has work completed on or before deadline 95% of the time.
  • Assumes daily responsibility for the access and quality of services provided to Community Care members through the care management department.
  • Supervises collection of information regarding the delivery and outcomes of Community Care services to members, and uses that information to recommend modifications to plan policies and procedures intended to improve the delivery of services to members.
  • Provides oversight of the teams providing clinical reviews, service authorization, and care coordination for all Community Care members.
  • Responsible for providing after-hours call support and supervision as required by the scheduled personnel.
  • Proposes and implements creative solutions to problems and to achieve a high level of member satisfaction with services.
  • Adheres to guiding principles of the organization.
  • Acts with the authority of the Director of Care Management and Member Services when designated.
  • Participates in making presentations to participating providers, state and federal agencies, community groups, and other interested parties.
  • Utilizes supervision effectively.
  • Reports clinical, utilization, and outcomes issues to Director of Care Management and Member Services.
  • Identifies provider issues and recommendations for improvement.
  • Independently problem solves based on sophisticated knowledge of behavioral health services for children and adults, the provider network, policies, members' rights and responsibilities, and the operating practices of the organization.
  • Advanced clinical knowledge.
  • Well-organized, reliable, and dependable.

 

Qualifications

  • Pennsylvania licensure and Master's Degree in health-related field OR licensed RN with Bachelor's Degree in nursing or related field.
  • 5 years of clinical behavioral health experience.
  • Management/leadership experience in behavioral health preferred.
  • Experience in children's and/or family-based services preferred. 
  • Experience in managed care strongly preferred.
  • General knowledge of best practices in behavioral health, emphasizing work with special needs populations and in public sector systems.
  • Strong working knowledge of managed care functional areas, including terms and definitions.


Licensure, Certifications, and Clearances:
Pennsylvania licensure: LSW, LCSW, LPC, licensed MFT, licensed RN, and/or a licensed PhD (psychologist).

  • 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)
  • Act 33
  • Act 34
  • Act 73 FBI Clearance

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct

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