Clinical Care Manager

Position Summary:
The Clinical Care Manager performs various clinical tasks supporting the utilization management functions of Advanced Behavioral Health, specifically related to the performance of the General Assistance contract. Performs clinical review of behavioral health cases including, but not limited to, the following duties:
Maintain familiarity and understanding of contract requirements related to the daily performance of clinical activities.
Provide telephone (ACD) coverage for incoming telephone calls to the clinical line for pre-certification, information and referral calls. Hours of coverage and call volume are assigned by the Assistant Clinical Director and are determined by business needs.
Perform case review for assigned providers, meeting all contract performance standards. Case review to be performed in a manner that seeks to build collaborative relationships with the provider community.
Identifies clients who could potentially benefit from services provided by the General Assistance Intensive Case Management Program (GAICM), including clients who are classified as “high utilizers”, clients identified as meeting criteria for participation in OATP or MH IV.2 treatment protocols, or any clients more likely to need community-based supports. Once identified, the Clinical Care Manager (CCM) will, during the routine review process, seek a signed consent to release information to the GAICM Program if the client resides in Regions 3 or 4.
Document fully and appropriately all clinical data collected during the review process, meeting all contract performance standards for documentation. This documentation should include, but not be limited to, Pre-/Post-Admission, Continued Stay, Discharge and Informational Reviews.
Provide clinical oversight and guidance for Utilization Management Review Support staff as needed to facilitate timely and correct processing of non-acute care authorization requests.
Identify episodes of care that have exceeded length of stay thresholds and refer identified cases to the Clinical Care Manager designated to perform Outlier reviews for their assigned region.
(For Clinical Care Managers assigned to Outlier Review) Perform telephonic reviews for any cases identified as exceeding length of stay thresholds to facilitate timely transition to a less intensive level of care.
Identify quality concerns related to providers in the Care Manager’s assigned region and notify the Assistant Clinical Director. As necessary, participate in targeted technical assistance and training for providers in collaboration with the Assistant Clinical Director.
Maintain confidentiality of all client protected health information and adhere to all HIPPA related policies and procedures.Other Responsibilities
REQUIREMENTS
Mental health or addiction treatment professionals with a current, active State of Connecticut professional license. Examples include Registered Nurses(RN), or Masters level Licensed Clinical Social Workers(LCSW), Licensed Marriage/Family Therapist (LMFT), or Licensed Professional Counselor (LPC). Direct experience in the delivery of mental health and addictions services for no less than a period of five (5) years
Cultural competency
Knowledge, Skills and Abilities:
Must be flexible in order to respond quickly and positively to shifting demands and changing management opportunities
Willingness to travel to provider sites as needed to provide technical support and assistance related to utilization management functions. Travel would be anticipated to occur at an average rate of 1-2 visits every 3 months
Excellent communication skills, both verbal and written
Computer skills, including knowledge of, and basic proficiency in, Microsoft applications, email and Internet.The Clinical Care Manager will complete a total of twenty (20) hours of annual training in substance abuse and mental health evaluation and treatment is required. This training requirement may be met by attendance/participation in outside seminars or workshops, or in other methods approved by the Assistant Clinical Director.