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Clinical Manager (Delaware county, PA)

  • Job ID: 226218964
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Community Care Behavioral Health
  • Department: Start-up
  • Location: 6505 Market Street, Upper Darby PA 19082
  • Union Position: No
  • Salary Range: $36.11 to $61.13 / hour

Description

At UPMC, we’re all here for the same reason – to make Life Changing Medicine happen. Join our team and you will play a unique and important role in our mission to change healthcare for the better.

UPMC is hiring a full-time Clinical Manager to support the Care Management team within the Community Care Behavioral Health (CCBH) business unit. This will be Monday through Friday daylight role and will be based out of Delaware county, PA. This position will be a hybrid role, with some travel to the office, as well as travel throughout Delaware and surrounding counties to provider sites, member residences, etc.

The Clinical Manager is responsible for supervising 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 Clinical Manager is responsible for the implementation of policies and procedures pertaining to Department functions and for monitoring Department operations consistent with those policies. The Manager also represents the organization to the general public and to member groups and participates in overall organizational management as warranted.

Previous behavioral health or mental health experience is preferred.
 


Responsibilities:

  • Recruit and train care management and other identified staff; supervise staff and conducts performance reviews as required by organization policies.
  • Assist with coordinating information and making presentations to participating providers, state and federal agencies, community groups and other interested parties.
  • Assist staff in aiding members, providers, prospective members and other departments with information concerning benefits and coverage.
  • Review all requests for out of network requests.
  • Work with Provider Relations and Quality Assurance staff to assure that systematic revisions to improve services are developed and implemented
  • Maintain 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.
  • Supervise 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.
  • Work with staff, members and providers to customize benefits to best meet members' needs within the policy parameters of the plan.
  • Monitor performance of care managers and implements corrective action plans for administrative and clinical issues.
  • Manage care management program, including compilation and analysis of trends. Develop care management interventions to address UM trends.
  • Responsible for training providers, Members, and staff on issues related to quality, including complaints, grievances, quality monitoring, quality workplan, significant member incidents.
  • Ensure outreach to appropriate priority populations.
  • Ensure adequate electronic and paper documentation of clinical interventions.
  • Supervise all clinical staff and ensures that all clinical reviews are consistent with medical necessity criteria.
  • Monitor departmental performance against NCQA, URAC, DPW and other appropriate internal and external standards.
  • Investigate claims and coverage inquiries from members and providers, gathers data and ensure appropriate follow-up of claim and service inquiries.
  • Ensure adequate staff coverage for all shifts and ensures clinical supervision of after hours clinical care.
  • Work with Customer Services Manager to coordinate activities between the two departments.
  • Responsible for oversight of monitoring of complaints and grievances.
  • Oversee complaint and grievance process from clinical perspective.

Qualifications

  • Appropriate state licensure and Master's degree in health related field OR licensed RN with Bachelor's in nursing or related field
  • 5 years progressive management experience in behavioral health
  • Strong background in managed care 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:
Appropriate state licensure, such as: 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)

    UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct