Licensed Professional Care Manager - Delaware County (Pre & Post Natal)

Job Description - Licensed Professional Care Manager - Delaware County (Pre & Post Natal) (260000HO) Job Description Licensed Professional Care Manager - Delaware County (Pre & Post Natal) - ( 260000HO ) Primary Location : USA-PA-Media Work Locations : 1400 N Providence Road 1400 N Providence Road 19063 Business Unit : Community Care Behavioral Health Schedule : Regular - Full-Time Shift : Day Job UPMC Community Care Behavioral Health is seeking a full time Licensed Professional Care Manager to join the Care Management team in Delaware County. This role follows standard Monday–Friday daylight hours and operates in a hybrid structure, with time spent traveling throughout Delaware and surrounding counties, working onsite in Media, PA, and remote work. Mileage is reimbursed at the IRS rate. This position will primarily support members receiving pre and post natal care. 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. In addition, a care manager may serve as the care management lead for other members of his/her team. Responsibilities: Makes Independently make authorization determinations for medically necessary services within licensure scope. Demonstrate strong knowledge of clinical treatment, case management, and community resources. Promote coordination of care with primary care, physical health plans and other key service providers. Monitor treatment effectiveness and recommend modifications to ensure appropriate, least restrictive care. Support members transitioning into or out of the county. Maintain excellent clinical, written, and verbal communication skills. Consistently meet deadlines, completing work on time at least 95% of the time. Develop outreach plans for members who struggle to maintain recommended provider contact. Implement clinical interventions to support optimal clinical and quality outcomes Collaborate with Member Services, Network Management, and Quality Management to improve service delivery. Assist with coordinating information and developing presentations to providers, agencies, and other key service providers Identify provider issues and recommend improvements. Manage a designated caseload across the continuum of care. Provide accurate information regarding behavioral health benefits and coverage. Facilitate linkages between behavioral health, primary care, and other social service or provider agencies to coordinate treatment and service Refer members to community based case management as appropriate. Maintain a sophisticated understanding of member needs and clinical best practices. Consult with physician advisors as needed for case collaboration and conceptualization Participate in case conferences and interagency planning meetings. Engage in ongoing professional development. Provide clinical expertise to Member Services and care management colleagues. Oversee collection and analysis of service delivery data to inform improvements and modifications to policies and procedures Maintain daily logs and contribute to weekly trend reporting. Collaborate with providers on assessments, treatment planning, and aftercare. Conduct clinical reviews, service authorizations, and care coordination (or oversight and supervision) for all assigned members receiving behavioral health services Independently problem solve using advanced knowledge of systems, policies, and member rights. Propose and implement creative solutions to improve member satisfaction. Maintain up to date knowledge of behavioral health benefits, policies, and procedures. Utilize supervision with the medical director and clinical manager regularly Participate in CQI activities and provider training. Customize services to meet member needs within Community Care guidelines. Receive and respond to complex and crisis calls. Address member and provider complaints per policy and procedures Qualifications : Pennsylvania Licensure in health or human services field and master's degree OR licensed RN (BSN preferred) OR Licensed Behavior Specialist (For IBHS levels of care only). Preference will be given to RN, LSW, LCSW, LPC, licensed MFT, or licensed PhD (psychologist). 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 as a Certified Addiction Counselor (CAC) or Certified Alcohol and Drug Counselor (CADC) is helpful. Supervisory or other leadership experience in behavioral health also preferred. Licensure, Certifications, and Clearances: A current and unrestricted Pennsylvania Licensure: RN, LSW, LCSW, LPC, licensed MFT, and/or a licensed PhD (psychologist). Licensed Behavior Specialist (for IBHS levels of care only). Preference will be given to RN, LSW, LCSW, LPC, licensed MFT, or licensed PhD (psychologist). *Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state. UPMC is an Equal Opportunity Employer/Disability/Veteran Union : No Salary Range : 29.01 - 48.21 Follow Us Careers My Account (External Candidates) Search Jobs Talent Network UPMC Careers Blog UPMC.com Info UPMC is an Equal Opportunity Employer Request Accommodations E-Verify FAQs Report Technical Issues