Join a team where your community is our first priority. At Community Care Behavioral Health Organization (CCBHO), we're committed to giving your neighbors the quality of life that they deserve. A proud part of the UPMC Insurance Services Division, we provide members with the behavioral health treatment they need for better health and a higher quality of life, including treatment for mental health conditions, drug or alcohol addiction, and developmental disabilities.
Community Care Behavioral Health partners with MetroPlus Health Plan to provide care to its members in the New York City area. With opportunities ranging from clinical to customer service, and everything in between, we're looking for highly motivated and compassionate individuals to join our diverse team where passion is nurtured and rewarded.
We are hiring a team of full-time Licensed Professional Care Managers to support the Care Management department within the Community Care Behavioral Health Organization (CCBHO) / MetroPlus business unit. This is a Monday through Friday daylight role (8:30 a.m. - 5:00 p.m. with varying shift coverage through 6:00 p.m.) and will be based out of New York City, NY.
Approximately 80% travel will be required within the five boroughs of New York City (i.e. Brooklyn, Manhattan, Queens, The Bronx and Staten Island). The Care Managers will travel throughout the community (to providers, members residences, and various human services organizations) to meet the needs of the members.
Applicants with experience working with individuals with co-occurring disorders or Credentialed Alcoholism and Substance Abuse Counselor (CASAC) certification is preferred.
A Care Manager is responsible for engaging individuals to access the most appropriate treatment service, at the right time for the best intensity. A Care Manager may work with a variety of priority populations. The individuals served may be covered by a range of insurance coverage. A Care Manager may be responsible for assisting HARP 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 field visits, discharge coordination, referrals to care plan of care development and care coordination as needed. The Care Manager 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. Care Managers are responsible to meet with members in their homes, hospitals and other outpatient settings.
Works as part of a team providing clinical expertise and knowledge to member services and other care management staff.
Participates in Continuous Quality Improvement (CQI) activities and provider training.
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
Conducts clinical assessments, develops plan and appropriate interventions, and care coordination (or oversight and supervision) for all assigned members receiving behavioral health services.
Assumes responsibility for a designated client case load.
Encourages coordination of care with primary care physician and other service providers integral to the member's life.
Identifies provider issues and recommendations for improvement.
Participates in professional development activities and interrater reliability activities
Demonstrates excellent clinical, written and oral communication skills.
Demonstrates knowledge of clinical treatment, case management, and community resources.
Responds to member and provider complaints according to Community Care's policies and procedures.
Assists with coordinating information and making presentations to participating providers, state and federal agencies, community groups and other interested parties.
Utilizes supervision with Medical Director, Clinical Manager and Coordinator regularly.
Works with the MCO and staff with appropriate professionalism and helpfulness
Responds to deadlines and has work completed on or before deadline 95% of the time.
Coordinates reviews and maintains daily logs for reporting purposes and for weekly preparation and analysis of trending reports.
Assists assigned members with smooth transition in assuring care coordination and service linkage when moving outside of the service area.
Makes recommendations for necessary services independently within the scope of practice of held licensure.
Proposes and implement creative solutions to member problems and to achieve a high level of member satisfaction with services.
Maintains contact with and refers members to health home case management services as appropriate.
Maintains close working relationships with the clinical leadership team.
Collaborates with providers and health homes in order to obtain initial assessment, treatment planning and aftercare planning for members.
Maintains an understanding of behavioral health benefits and remains current on covered benefits, limitations, exclusions, and policies and procedures, in regards to services.
Provides members, providers, and other stakeholders with accurate information concerning behavioral health care benefits and coverage.
Possesses excellent clinical skills with sophisticated understanding of the overall needs of individual members assigned.
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.
Receives and responds to complex and crisis calls.
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.
Works with Member Services, Network Management, Provider Relations and Quality Management staff to assure that systematic revisions to improve services are developed and implemented.
Consults with appropriate physician advisors as needed for case collaboration and care planning.
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.
Proficiency in operating computer software.
Develops specific outreach plans for assigned members who do not maintain regular contact with their behavioral/ physical health provider as recommended contributing to frequent crises, re-admissions, loss to care, and interfering with maximum benefit from available care.
Implements appropriate clinical interventions to ensure optimal clinical and quality outcomes for members.
Attends case conferences, inter-agency and provider treatment planning meetings for assigned members.
Works with members and providers to customize services to best meet members' needs within the scope of Community Care's obligations to its members.
New York Licensure in health or human services field and master's degree OR licensed RN with Bachelor's degree in nursing or related field.
Minimum of three years of relevant clinical experience.
Experience in managed care strongly preferred.
Certification in substance use disorders helpful.
Supervisory or other leadership experience in behavioral health also preferred
General knowledge of best practices in behavioral health, emphasizing work with special needs or priority populations, including children and adults with SMI and SUD.
Licensure, Certifications, and Clearances:
Justice Center Clearances (SEL)
Licensed in NY as a Licensed Master Social Worker (LMSW), Licensed Clinical Social Worker (LCSW), Licensed Marriage Family Therapist (LMFT), Licensed Mental Health Counselor (LMHC), Registered Nurse (RN) or Psychologist
Credentialed Alcoholism and Substance Abuse Counselor (CASAC) preferred
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities Salary Range: $27.43 to $46.22 / hour
Union Position: No
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.