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Licensed Professional Care Manager, Precert / Digital Health Coaching

  • Job ID: 191969636
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Community Care Behavioral Health
  • Department: Care Management Precert
  • Location: 336 Sixth Avennue, Pittsburgh PA 15222
  • Union Position: No
  • Salary Range: $24.05 to $41.60 / hour

Description

Community Care is now hiring a full-time Care Manager for the Precert Team to provide digital health coaching to Community Care members enrolled in health condition management programs. This position will work with Community Care members who want to improve their health and wellbeing by using a variety of digital tools and mobile applications.  The Digital Health Coach will merge motivational interviewing techniques and technology to facilitate health behavior change skills in members who choose a digital health intervention in one or more of the following areas: Depression, Anxiety, Stress Management, Weight Management, Physical Activity, Tobacco Cessation, and Nutrition. 

This position is also responsible for supporting the care management Precert team by reviewing and documenting clinical information to make authorization determinations for members being referred to acute and non-ambulatory behavioral health and substance use disorder (SUD) levels of care.

This is a Monday through Friday daylight position (8:30 a.m  to 5:00 p.m.), with occasional holiday and weekend Precert coverage. The position does not require travel and is a fully remote / home-based position in Pennsylvania.

 



Responsibilities:

  • 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.
  • Provides members, providers, and other stakeholders with accurate information concerning behavioral health care benefits andcoverage.
  • 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.
  • Posesses 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 torecommend 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.
  • Use technology and digital communication tools to facilitate behavior change. 
  • Motivate, guide, and help members navigate through programs or coaching interventions to meet their health goals successfully.
  • Engage members in regular contact in the collaborative development of a personalized behavior change plan to address risk factor(s) in conjunction with their health care team.

  • Use excellent written and oral communication skills to move participants through digital interventions.

  • Use workflows as a guide to action while using sound clinical judgement to proceed appropriately

  • Employ strategies for encouraging individuals to explore motivation for change and enhance readiness

    *Perform in accordance with system-wide competencies/behaviors.

    *Perform other duties as assigned.

Qualifications

  • Pennsylvania Licensure in health or human services field and master's 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)
 

  • 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)


    UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct