Do you have an active PA Human Services Licensure? Do you have a strong background in behavioral health? Are you experienced with case management and in home visits? If so, UPMC may have the perfect fit for you!
UPMC is hiring a full time Licensed Professional Care Manager to support our Community team! This will be a Monday through Friday daylight role. This Care Manager will travel throughout Blair county and surrounding counties to meet with community members and providers.
The Licensed Professional Care Manager will be based out of the US Steel Building in Pittsburgh, Pa however will be remote within communities. They will be expected to undergo training and attend meetings in Pittsburgh, Pa as needed.
A Care Manager is responsible for assisting members identified at risk for recidivism, discontinuous care, or as members of priority or special needs populations who present with complex needs for coordination of their behavioral health services with other aspects of their care. The care manager is responsible for assisting these assigned members to care at all levels of the continuum, and for providing any and all required pre-certification, continued stay and/or discharge reviews; service authorization, and care coordination as needed. The Care Manages executes these responsibilities consistent with the applicable Community Care Policies and Procedures. A care manager represents the organization to providers, member groups and families, and participates in the overall administration of clinical operations as warranted. A care manager is expected to bring a level of clinical leadership to the care management department. These care managers are specifically chosen based upon a targeted area of practice, supported by education, training, and experience, with expertise in the delivery of behavioral health care to a given population. In addition, a care manager may serve as the care management lead for other members of his/her team.
Assists assigned members with smooth transition when moving into or out of the county.
Assists with coordinating information and making presentations to participating providers, state and federal agencies, community groups and other interested parties.
Assumes responsibility for a designated client case load.
Attends case conferences, interagency and provider treatment planning meetings for assigned members.
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.
Consults with appropriate physician advisors as needed for case collaboration and care planning.
Coordinates, reviews and maintains daily logs for reporting purposes and for weekly preparation and analysis of trending reports.
Demonstrates excellent clinical, written and oral communication skills.
Demonstrates knowledge of clinical treatment, case management and community resources.
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.
Encourages coordination of care with primary care physician and other service providers integral to the member's life.
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.
Identifies provider issues and recommendations for improvement.
Implements appropriate clinical interventions to ensure optimal clinical and quality outcomes for members.
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.
Maintains an understanding of behavioral health benefits and remains current on covered benefits, limitations, exclusions, and policies and procedures, in regards to services.
Maintains contact with and refers members to community based case management services as appropriate.
Makes authorization determinations for medically necessary services independently, within the scope of the practice of held licensure.
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.
Participates in CQI activities and provider training.
Participates in professional development activities.
Possesses excellent clinical skills with sophisticated understanding of the over-all needs of individual members assigned to him or her.
Proposes and implements creative solutions to member problems and to achieve a high level of member satisfaction with services.
Provides members, providers, and other stakeholders with accurate information concerning behavioral health care benefits and coverage.
Receives and responds to complex and crisis calls.
Responds to deadlines and has work completed on or before deadline 95% of the time.
Responds to member and provider complaints according to Community Care's policies and procedures.
Supervises collection of information regarding the delivery and outcomes of services to members, and uses that information to recommend modifications to plan policies and procedures which improve the delivery of services to members.
Utilizes supervision with medical director and clinical manager regularly.
Works as part of a team providing clinical expertise and knowledge to member services and other care management staff.
Works with Member Services, Network Management and Quality Management staff to assure that systematic revisions to improve services are developed and implemented.
Works with members and providers to customize services to best meet members' needs within the scope of Community Care's obligations to its members.
Pennsylvania Licensure in health or human services field and masters 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)
Act 33 Child Clearance with Renewal
Act 34 Criminal Clearance with Renewal
Act 73 FBI Clearance
Clinical Social Worker
Licensed Marriage & Family Therapist
Licensed Professional Counselor
Licensed Social Worker
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities