Job Description

Job Title: Associate Clinical Manager - Utilization Management
Job ID: 82240144
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: Community Care Behavioral Hlth
Department: CM Admin-Satellite
Location: 200 Corporate Drive, Camp Hill PA 17011

Description

Are you a licensed professional with at least 5 years of clinical experience and 2 years of related management/leadership experience? Do you have experience with high risk care management? If so, UPMC may have the perfect fit for you!

UPMC is hiring a full-time Associate Clinical Manager (Utilization Management) to support the Administration department. This is a Monday through Friday daylight role (8:30 a.m. – 5:00 p.m.) and will be based out of the Camp Hill, PA office location. Minimal travel is required.

Experience with acute care, substance use disorders and/or chronic needs is preferred.

The Associate Clinical Manager is responsible for overseeing the day-to-day operations of the Care Management Department. This responsibility includes daily supervision of the Care Management representatives to ensure that they respond promptly, effectively and courteously to inquiries from members, providers, prospective members and the general public. The Associate Clinical Manager is responsible to the Clinical Manager for the implementation of policies and procedures pertaining to Department functions and for monitoring Department operations consistent with those policies. The Associate Clinical Manager also represents the organization to the general public and to member groups and participates in overall organizational management as warranted and designated by the Clinical Manager.


Responsibilities:
  • Assists with coordinating information for presentations to participating providers, state and federal agencies, community groups and other interested parties.
  • Ensures outreach to appropriate priority populations.
  • Co-chairs appropriate administrative and clinical meetings within the department.
  • Development and oversight of specific clinical interventions to ensure optimal clinical and quality outcomes; interventions may be telephonic or field based.
  • Ensures adequate staff coverage for all shifts and ensures clinical supervision of after hours clinical care.
  • Identifies and improves systems communication within the department and external to the department.
  • Train licensed and non-licensed care management and other Community Care staff; supervise staff and conducts performance reviews as required by organization policies.
  • Ensures adequate documentation of clinical interventions.
  • With the Clinical Manager, manages care management program, including compilation and analysis of trends. Develops care management interventions to address UM trends.
  • Ability to propose and implement creative solutions to care management and staff problems and to achieve a high level of satisfaction with workplace issues and workflow.
  • Supervises collection of information from members concerning problems with accessing services and/or benefits and uses that information to recommend modifications to plan policies and procedures which improve the flow of services to members.
  • Maintains understanding of benefits and assures that department staff are current on covered benefits, limitations, exclusions, policies and procedures, computer screens and code definitions and maintains current awareness of Plan changes and developments.
  • Responsible for internal coordination and training within the Care Management Department.
  • Supervises licensed and non-licensed staff and ensures that all clinical reviews are consistent with medical necessity criteria.
  • Provides consultation and leadership to the the coordinators of other services within Care Management.
  • Serves as clinical resource to the Care Management Department for high risk care management and care management of members with complicated clinical needs.
  • Ability to propose and implement creative solutions to member problems and to achieve a high level of member satisfaction with services.
  • Assists staff in aiding members, providers, prospective members and other departments with information concerning benefits and coverage.
  • Independent problem solving based on sophisticated knowledge of the provider network, strong clinical presence, Care Management policies, members' rights and responsibilities, and the operating practices of the organization.
  • Responsiveness to deadlines and has work completed on or before deadline 95% of the time.
  • Monitors performance of care managers and implements corrective action plans for administrative and clinical issues.
  • Excellent written and oral communication skills.
  • The position reports to the Clinical Manager of the organization and has a matrix report to the VP of Medical Affairs. The position assists with supervision of the Care Management Staff and appropriate support staff. The incumbent participates in the organization's management team.

Qualifications

  • Pennsylvania licensure and Master's degree in health-related field OR licensed RN with Bachelor's in nursing or related field
  • Five or more years of clinical experience
  • Two years' management/leadership experience in behavioral health 
  • Experience in managed care strongly preferred
  • Advanced knowledge of best practices in health and human services, emphasizing work with special needs populations and in public sector systems.

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 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance

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

    Salary Range: $31.82 to $54.34 / hour

    Union Position: No

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