- Facilitate care coordination with system partners to address social determinants, barriers to wellness, and other needs of members, including connection to appropriate community-based services.
- Carries a caseload of provider agencies and acts as the liaison and primary contact to those agencies.
- Authorizes and reauthorizes the continuation of treatment or recommends and facilitates necessary changes in the levels of care.
- Performs on-site utilization review activities as needed which may include, but are not limited to, the review of client charts, documentation of treatment services, completion of required paperwork, confirmation of attempt to establish M.A. eligibility.
- Performs telephonic screenings as required and clinical dispositions as needed.
- Monitors program eligibility of active patients via the Department of Welfare's PROMISe & e-CIS systems. Appropriately manage cases based on eligibility.
- Ensures all required client paperwork is received and complete.
- Maintain documentation in BHSI's electronic system consistent with agency and industry standards.
- Work collaboratively with team members including assisting with the training of newly hired employees as requested, covering work when peers are out of the office as assigned.
- Display clinical integrity, advocacy and commitment to member and family driven care and principles of resiliency and recovery.
- Other duties as assigned.
- Excellent clinical case conceptualization skills
- Maintain high levels of advocacy. Possess the ability to actively listen and work to resolve grievances expressed by the provider network and community members, while exercising care and compassion.
- Proactive planning and meeting facilitation
- Customer service
- Familiar with psychiatric and medical conditions and concurrent medication usage
- Excellent verbal and written communication skills and ability to use them when communicating with internal and external stakeholders.
- Excellent interpersonal and collaboration skills
- Proficient in MS Office, especially with 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 and ability to multi-task
- Compliant with HIPAA and Confidentiality regulations
- Bachelor's degree in related field with 3 years of relevant work experience in SUD;
- Bachelor's degree and 5 years of relevant work experience in SUD
- Master's degree in related field with 2 years of relevant work experience in SUD
- Master's degree with 3 years of relevant work experience in SUD.
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Substance Use Disorder - Philadelphia, United States - PMHCC, Inc.
Description
Position Summary:The Clinical Service Manager is responsible for utilization management by conducting utilization review activities, population management, cross-system consultation, provider management and treatment quality monitoring. The Clinical Service Manager must utilize clinical knowledge of best practices and evidence-based treatments to ensure BHSI members receive timely access to quality, medically necessary behavioral health services.
Duties and Responsibilities:
Authorize and reauthorize treatment utilizing ASAM Criteria.
PMHCC, Inc. is committed to equal opportunity. It is our policy to support equal employment for all employees and applicants without regard to race, religion, color, sex, sexual preferences, age, national origin, disability, behavioral health status, military status or any other characteristic protected by law.
Americans with Disabilities Act:
Employees as well as applicants who are currently, or become disabled, must be able to perform the functions of the job with either reasonable accommodation or unaided. PMHCC, Inc. will examine reasonable accommodations on a case by case basis in accordance with the law.
