Clinical Care Manager - HealthChoices Program

Location
Bedford, PA
Posted
May 16, 2017
Institution Type
Outside Academe


Job Description

Clinical Care Manager - Health Choices Program

DATE POSTED: 5/15/17

LOCATION: Bedford, PA

Moderate Travel Required

LAST DAY TO APPLY: 5/26/17

If the position is not filled, applications will be accepted on an ongoing basis.

TYPE OF POSITION: Full-Time

WORK HOURS (37.5 HRS/WK): Monday - Friday 8:30 am to 4:30 pm

The Clinical Care Manager is responsible for understanding the Behavioral Health service delivery system; access to community supports and behavioral health treatment services; and working closely with the Member, Member's family, and providers to determine appropriate level of care to meet treatment needs. The Clinical Care Manager is responsible to ensure that treatment delivered is medically necessary, appropriately utilized and meeting the Member's needs in the least restrictive, least intrusive manner possible.

The HealthChoices Clinical Director supervises this position.

Essential Functions:

Conduct Concurrent reviews for BHRS, RTF, CRR-HH, and Family Based Mental Health Services; make appropriate determinations regarding level of care based on medical necessity criteria and complete authorizations within established timeframes.

Review of BHRS, RTF, CRR-HH and Family Based Mental Health Services treatment plans, functional behavior analyses and evaluations to determine if they meet best practice guidelines.

Collect all clinical information for prior authorization of Mental Health Inpatient /Partial Hospitalization Program and Substance Abuse Rehab; conducts clinical screening, make appropriate determinations regarding level of care based on medical necessity criteria, and complete authorizations within established timeframes.

Review information and document findings from Members, families, providers, and other involved persons to determine an appropriate level of care.

Direct Member care through the authorization of services and discharge planning.

Consider all information available to ensure that authorizations are not provided for unbundled, excessive, or duplicative services.

Actively participate in CASSP, ISPT, and treatment plan meetings to provide education and assistance in navigating the treatment team through the HealthChoices system, as well as documentation of meeting discussions and outcomes.

Report utilization trends, clinical issues, and operational concerns regarding Level of Care (LOC) within Behavioral Service Delivery System to the Clinical Director and the Quality Management Director.

Report any treatment concerns to the Clinical Director and the Quality Management Director. Report any atypical or inappropriate authorization requests to Clinical Director.

Clinical Care Mangers are responsible for submitting all Level of Care (LOC) requests that may not meet Medical Necessity Criteria (MNC) to a PerformCare Physician Advisor (PA) for review and final determination of approval or denial of care. A Clinical Care Manager is not permitted to deny a request for services, only a PerformCare PA may issue a denial of care.

Maintain caseload as assigned.

Actively participate in regular, internal clinical meetings to do case consultation, and be familiar with utilization trends, best practices, and operational concerns with level of care, inappropriate treatment requests, treatment concerns, quality of care issues and any other clinical related topics.

Adhere to all documentation requirements as outlined in the PerformCare Agency and Clinical policies, procedures, and internal processes.

Adhere to all BHSSBC policies and procedures including but on limited to: Personnel policy, Code of Ethics, HIPAA and Confidentiality, and Corporate Compliance.

Adhere to all PerformCare policies and procedures relating to Clinical Care Management.

Non-Essential Duties:

Perform additional duties as assigned.

APPLICANT MUST:

1. Meet the minimum experience and training requirements:

Required Education:

A Licensed Social Worker (LSW), Licensed Clinical Social Worker (LCSW) or a Licensed Professional Counselor (LPC) or

LSW, LCSW, LPC candidates.

*Must be a Pennsylvania License

Desired:

A Licensed Social Worker (LSW), Licensed Clinical Social Worker (LCSW) or a Licensed Professional Counselor (LPC) or

LSW, LCSW, LPC candidates.

*Must be a Pennsylvania License

Experience:

Three (3) years of clinical experience. Desired: Two (2) years managed care experience

Specialized Skills:

Strong written and oral communication skills

Ability to perform multiple tasks

Excellent interpersonal, time management and organizational skills

Ability to work effectively in a team environment

PC skills and experience utilizing Microsoft Office, Outlook, Excel, Power Point

Desired: Strong documentation skills and analytical abilities, investigative abilities and the ability to lead team meetings.

2. Applicants must submit a cover letter and resume by 02/29/16 to apply.

The cover letter must indicate how you meet the qualifications.

Company Description
Behavioral Health Services of Somerset & Bedford Counties (BHSSBC) HealthChoices Program is the Multi-County Management Entity created by the counties of Somerset and Bedford to oversee the management of the Medicaid HealthChoices Behavioral Health Program. The BHSSBC Health Choices Program has direct responsibility for all management and administrative functions associated with (1) the contract between the counties and the Commonwealth of Pennsylvania for the provision of Medicaid covered services and (2) the contract between the counties and the Behavioral Health Managed Care Organization (BH-MCO) that it chooses as a subcontractor to administer the program to Medicaid recipients.
http://www.bhssbc.org/


Bedford, PA

dfaa220a9

Fri, 5 May 2017 14:56:00 PDT

PI97851500