Clinical Care Management Specialist - High Fidelity Wrap svs.

Part of a specialized team providing high-intensity care management, working collaboratively and directly with members and providers to ensure effective, holistic, member-centric care. Training and certification in High-Fidelity Wraparound, an evidence-based care management intervention, will be provided.

Responsibilities

• Work directly with members, natural supports, and providers in the community, including in members’ homes.
• Facilitate care coordination using an inter-generational approach with system partners to address social determinants, barriers to wellness, and other member needs, including connection to community-based services.
• Create and maintain a team of system partners and natural supports for each member and their family.
• Complete an effective Crisis Prevention Plan in collaboration with each assigned member and their team.
• Apply knowledge of behavioral health care services, system partners, service continuum, and medical necessity criteria in all work activities.
• Attend up to 3 hours of group or individual skills-based coaching/supervision per week.
• Complete Utilization Management activities, including interagency meetings, social determinants interviews, treatment team meetings, case consultations, care coordination, provider meetings, reviews, and treatment linkage within established timeframes.
• Authorize treatment when Medical Necessity Criteria is met.
• Consult with Physician Advisor, Psychologist Advisor, and/or Clinical Leadership as clinically appropriate.
• Generate denial letters based on physician reviews and in accordance with state regulations as needed.
• Demonstrate an understanding of Evidence-Based Practices (EBPs) and connect members to appropriate evidence-based treatment.
• Collaborate with other CBH departments to ensure quality of care, promote placement in the most appropriate services, and facilitate consistent longitudinal care management.
• Document provider quality concerns in accordance with CBH policy/procedure.
• Use data to inform clinical decision-making.
• Maintain documentation in CBH’s electronic system consistent with agency and industry standards.
• Respond to care coordination correspondence within 24-48 hours or sooner if necessary.
• Attend all meetings as assigned and actively prepare for and participate in supervision and clinical case consultations.
• Ensure the highest quality of customer service when interacting with members, providers, and other stakeholders.
• Display commitment to member/family-driven care and principles of resiliency and recovery.
• Facilitate monthly interagency HFW Planning Meetings (includes youth/family participation) for a caseload of approximately 10 members and their families.
• Write, revise, and distribute individualized Wraparound Plans and Discovery documents to members’ teams monthly.
• Ensure the principles and steps of the High-Fidelity Wraparound process are delivered with the highest possible fidelity.
• Provide evidence-based intensive care management interventions directly to members in the community.
• Maintain a care management caseload of approximately 10 members (or as otherwise directed).
• Facilitate care coordination with external entities including behavioral and physical health providers, Child Welfare, Juvenile Justice, School District of Philadelphia, and Targeted Case Management (TCM), as well as any other providers or systems involved with assigned members’ families.
• Address member/caregiver engagement in treatment by reporting or addressing quality concerns, resolving communication barriers, assisting with mediation issues, and increasing positive collaboration with providers and other supports.
• Facilitate longitudinal care management of all assigned members.
• Complete UM activities as assigned and within required timeframe.
• Participate in and complete training and credentialing in the High-Fidelity Wraparound model of care management.
• Contribute to projects and other duties as assigned.

Requirements

• Master’s degree in Social Work or related field.
• Qualified candidates are required to obtain licensure within the first 18 months (1.5 years) of employment.
• PA Child Abuse Clearance required.
• Licensed Social Worker (LSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), or Licensed Clinical Social Worker (LCSW).
• Minimum of 3 years of direct clinical care experience working with adults, children, adolescents, and/or their families in behavioral health settings, including experience in assessment and treatment planning; and/or experience in a managed care setting.

Skills

• Excellent clinical case conceptualization skills.
• Meeting facilitation.
• Proactive planning.
• Customer service.
• Familiarity with medications.
• Excellent verbal and written communication skills, including ability to communicate with internal and external stakeholders.
• Excellent interpersonal and collaboration skills.
• Conflict and crisis management.
• Reliable, accountable, resourceful, curious, flexible, and creative.
• Empathetic (accepting/non-judgmental).
• Proficient in MS Office, especially Excel, and able to type at least 40 words per minute.
• Ability to work independently and as part of a team.
• Excellent time management and prioritization skills, including ability to multi-task.

Work Conditions

• Must be able to travel within Philadelphia and surrounding counties.
• Regularly requires walking, standing, stooping, bending, sitting, reaching, pushing, pulling, and/or repetitive wrist/hand movements for various lengths of time throughout the day.
• Ability to utilize computers and office equipment to complete daily work responsibilities.
• Regularly works inside in areas that are adequately lighted and ventilated. Some fluctuation in temperature. No protective equipment routinely needed.
• Must be able to adapt to continuous changes/demands of the job.
• Must be a current Philadelphia resident or become a resident within six months of hire.
• Maintain a flexible schedule, which may include some evenings or occasional weekends, to accommodate the scheduling needs of assigned members and their families.