Clinical Care Manager - Neurodevelopmental services

About the Role

The IBHS Clinical Care Manager – Neurodevelopmental Services (CCM-ND) is responsible for utilization management, including utilization review activities, population management, cross-system consultation, provider management, and treatment quality monitoring. The role ensures CBH members receive timely access to quality, medically necessary behavioral health services for individuals with Autism spectrum and other neurodevelopmental disorders, utilizing clinical knowledge of best practices and evidence-based treatments such as Applied Behavior Analysis (ABA). When clinically indicated, the Clinical Care Manager consults with CBH Physician and Psychologist Advisors to ensure effective treatment authorization.

Responsibilities

• Apply knowledge of behavioral health care services, system partners, service continuum, and medical necessity criteria in all work activities.
• Complete Utilization Management (UM) activities, including:
  • Interagency meetings, social determinants interviews with members, treatment team meetings, case consultations, care coordination, provider meetings, reviews, and treatment linkage.
  • Expected number of UM activities per day/shift as specified by team responsibilities within established timeframes.
• Authorize and extend treatment authorizations when Medical Necessity Criteria are met.
• Consult with Physician Advisor, Psychologist Advisor, and/or Clinical Supervisor as clinically appropriate.
• Generate denial letters based on physician consults and in accordance with state regulations.
• Complete discharge reviews in a timely manner.
• Work directly with members, natural supports, and providers in the community for 30-75% of work hours (6-15 days per month).
• Facilitate care coordination with system partners to address social determinants, barriers to wellness, and other member needs, including connection to community-based services.
• Demonstrate understanding of Evidence-Based Practices (EBPs) and connect members to appropriate evidence-based treatment at admission, during treatment, and at discharge.
• Monitor member’s length of treatment and collaborate with providers to address barriers to treatment in less restrictive environments.
• Collaborate with other CBH departments to ensure quality of care and promote placement in the most appropriate services.
• Document provider quality concerns in accordance with CBH policy/procedure.
• Conduct provider meetings at least 4 times per year.
• Use data to inform clinical decision-making.
• Maintain documentation in CBH’s electronic system consistent with agency and industry standards.
• Participate in grievance/complaint hearings as assigned.
• Respond to care coordination correspondence within 24-48 hours or sooner if necessary.
• Work collaboratively with team members, including training new hires, covering work for peers, and arranging coverage when absent.
• Attend assigned meetings and actively prepare for and participate in supervision and clinical case consultation.
• Maintain an accurate daily log of work completed.
• Contribute to projects and other duties as assigned.

Team-Specific Responsibilities

• Manage ABA-Designated Providers within the IBHS Level of Care and consult with teams managing other Levels of Care as needed (e.g., Child Acute, RTF).
• Complete an average of 8-15 utilization management (UM) activities per day.
• Review service authorization requests, including:
  • Review of Written Orders, Physician consultation per Review Guidelines, provider notification, referral submission (if required), denial letters (if required), authorization generation (if required), and logging of reviews.
• Participate in at least 8 inter-agency or inter-disciplinary team meetings per month for members receiving or recommended for ABA Services.
• Ensure collaboration and continuity of care for members with multiple services or in multiple child-serving systems.
• Facilitate collaboration with community-based treatment teams for members experiencing a crisis.
• Conduct crisis consultations for members receiving ABA, including supporting access to higher levels of care and return to community-based services.
• Conduct progress monitoring reviews for members in need of intensive care management or as indicated by provider outlier performance.
• Complete service authorizations accurately and as assigned.
• Implement provider management strategies, including review of metrics and key performance indicators, and promote transparent dialogues regarding compliance or performance concerns.

Requirements

• Education: Master’s degree in Applied Behavior Analysis, Psychology, or Special Education preferred. Master’s degree in a closely related field (e.g., Social Work, Counseling) with at least 18 credits in graduate-level ABA coursework accepted.
• License/Certification:
  • Pennsylvania License as a Behavior Specialist (BSL) required.
  • PA Child Abuse Clearance required.
• Relevant Work Experience: Minimum of 2 years of direct clinical experience with children, with experience in providing ABA services to individuals with Autism spectrum or other neurodevelopmental disorders strongly preferred.

Skills

• Excellent clinical case conceptualization skills.
• Meeting facilitation.
• Proactive planning.
• Customer service.
• Flexibility and acceptance of change.
• Excellent verbal and written communication skills for internal and external stakeholders.
• Excellent interpersonal and collaboration skills.
• Proficient in MS Office, especially Excel, and ability to type at least 40 words per minute.
• Ability to work independently and as part of a team.
• Excellent time management, prioritization, and multi-tasking skills in a fast-paced environment.
• Commitment to professional ethics code (e.g., BACB, APBA).
• Compliance with HIPAA regulations.

CBH does not provide sponsorship for applicants requiring future work authorization. All candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future.