The IBHS Clinical Care Manager – Neurodevelopmental Services (CCM-ND) is responsible for utilization management by conducting utilization review activities, population management, cross-system consultation, provider management and treatment quality monitoring. The Clinical Care Manager must utilize clinical knowledge of best practices and evidence-based treatments, including Applied Behavior Analysis, for individuals with Autism spectrum and other neurodevelopmental disorders, to ensure CBH members receive timely access to quality, medically necessary behavioral health services. When clinically indicated, Clinical Care Managers consult with CBH Physician and Psychologist Advisors to ensure the most effective treatment for the CBH member is being authorized.
- Be knowledgeable about behavioral health care services, system partners, service continuum and established medical necessity criteria and apply that knowledge in all work activities.
- Complete Utilization Management activities including but not limited to: interagency meetings, social determinants interviews with members, treatment team meetings, case consultations, care coordination, provider meetings, reviews, treatment linkage.
- Complete expected number of UM activities per day/shift as specified under team specified under team specific responsibilities in established timeframes.
- Authorize and extend treatment authorizations when Medical Necessity Criteria is 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 as needed.
- Complete discharge reviews in a timely manner.
- Work directly with members, natural supports and providers in the community during 30-75% of work hours or 6-15 days per month.
- 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.
- Demonstrate an 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 work collaboratively with providers and other systems to address barriers to member receiving treatment in a less restrictive environment.
- Collaborate with other CBH departments to ensure quality of care, promote placement of members in the most appropriate services and to facilitate consistent longitudinal care management.
- 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.
- Understand and 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 assisting with the training of newly hired employees as requested, covering work when peers are out of the office as assigned and finding coverage when absent.
- Attend all meetings as assigned 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, consult to teams managing other Levels of Care, as needed or assigned (e.g., Child Acute, RTF).
- Complete an average of 8-15 utilization management (UM) activities per day.
- Complete thorough and accurate reviews of service authorization requests, including review of Written Orders, Physician consultation per Review Guidelines, provider notification, referral submission (if required), denial letter (if required), authorization generation (if required), and log of review.
- Participate in at least 8 inter-agency or inter-disciplinary team meetings per month for members being recommended for, or receiving, 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 team for members experiencing a crisis.
- Conduct crisis consultations for members receiving ABA, as needed, including supporting member through 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 clinical audit tools or chart reviews, as clinically indicated.
- Implement provider management strategies, including review of metrics and key performance indicators, promoting transparent dialogues with all providers with regards to areas of strength or outlying performance concerns.
- 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 coursework in ABA accepted.
- License/Certification: BCBA or BCBA-eligible within 1 year of accepting position preferred. If not BCBA or BCBA-eligible, must have Pennsylvania License as a Behavior Specialist (BSL) and LSW, LCSW, LPC or LMFT eligible within one year of hire.. PA Child Abuse Clearance required.
- Relevant Work Experience: Minimum of 2 years direct clinical experience with children required, with experience in the provision of ABA services to individuals with Autism spectrum or other neurodevelopmental disorders strongly preferred.
- Excellent clinical case conceptualization skills
- Meeting facilitation
- Proactive planning
- Customer service
- Flexibility and acceptance of change
- 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 in a fast-paced environment
- Commitment to professional ethics code (e.g., BACB, APBA)
- Compliant with HIPAA regulations