Key Facts

Remote From:

Pennsylvania (USA)

Category: Customer Care Manager (B2C)

Full time

Mid-level (2-5 years)

English

Hard Skills

Care Coordination Utilization Management Case Assessment Behavioral Health Electronic Health Record Applications Clinical Informatics Evidence-Based Practice Healthcare Quality Employee Onboarding Stakeholder Engagement +11 more

Other Skills

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Microsoft Excel
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Typing
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Advocacy
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Microsoft Office
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Non-Verbal Communication
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Adaptability
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Multitasking
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Time Management
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Teamwork
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Cultural Humility
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Customer Service
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Social Skills
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Professional Responsibility
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Problem Solving

Roles & Responsibilities

Master's degree in Social Work or related clinical field
Licensure/certification preferred (LSW, LPC, LMFT, or LCSW); must be eligible and willing to obtain full licensure
PA Child Abuse Clearance required
Minimum of 3 years of direct clinical experience providing behavioral health services with children, adolescents, and/or adults, including assessment, treatment planning, and interdisciplinary care coordination

Requirements:

Review and assess service requests for medical necessity, actively monitor treatment, document utilization management activities, and conduct discharge/concurrent reviews within team productivity guidelines
Facilitate care coordination through inter-agency meetings and treatment planning; promote member-centered collaboration with natural supports, providers, and system partners, addressing social determinants of health; may work in the community 6–15 days per month depending on team needs
Conduct provider engagement and quality monitoring by leading provider/stakeholder meetings, monitoring length of stay and progress toward goals, documenting quality concerns, and collaborating with internal teams to address trends
Provide clinical collaboration and documentation by consulting with Physician/Psychologist Advisors and Clinical Supervisors; participate in clinical case consultations and supervision; ensure accurate, timely documentation and respond to correspondence within 24–48 hours; maintain daily work logs and participate in audits

Community Behavioral Health

About Community Behavioral Health

CBH is a nonprofit 501 (c)(3) corporation contracted by the City of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services to manage the delivery of behavioral health services for Medicaid recipients of Philadelphia County. For more information about CBH, visit cbhphilly.org. For more than 25 years, Community Behavioral Health (CBH) has been expanding access to mental health services for Philadelphians. CBH provides access to high-quality, accountable care to improve the health and mental wellness of our Members. Our Mission: CBH provides access to high-quality accountable care to improve the health and mental wellness of our members. Our Vision: Leading innovation in whole-person care for healthy, thriving communities. Our Values: We Care. We value and appreciate our staff and service providers, believing that a healthy, happy workforce creates healthy, happy members. We show our appreciation regularly and listen to concerns. We also care deeply for the overall health of Philadelphians, knowing that a vibrant, thriving, resilient city hinges upon healthy citizens. We Empower. We are here for our employees, members, and partners. We are open and transparent, encouraging dialogue and fostering growth so we can all be our best, healthiest selves. We Connect. We’re updating our processes and technology to better serve our community and communicate more effectively and efficiently. We cultivate two-way communication, sharing our appreciation for our staff and welcoming feedback from them. We Lead. Behavioral and mental wellness is our passion, and we are experts in the field. We have been serving the Philadelphia community since 1997, and we know the industry. We cultivate close working relationships with our partners, who are also leaders in the mental health field. We are open to change and innovation to ensure the highest standard of care for all.

Founded: 2018

Company size: 501 - 1000

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Job description

The Clinical Care Manager (CCM) is responsible for delivering integrated, whole person care management to individuals with complex behavioral needs. The CCM facilitates care coordination across multiple systems, ensures timely utilization management (UM) activities, and promotes collaboration between providers, members, and support systems to improve health outcomes. Clinical Care Managers are assigned to specific teams based on population needs and service settings, with some responsibilities tailored to those contexts. The ideal candidate has strong clinical conceptualization skills, experience working with the Medicaid population, and is passionate about health equity for all Philadelphians.

Essential Functions

Utilization Management (UM)

Review and assess service requests in accordance with Medical Necessity Criteria and regulatory requirements.
Actively monitor course of treatment ensuring high quality whole person care.
Document UM activities in electronic systems and generate denial letters when applicable.
Conduct discharge reviews and concurrent reviews as assigned.
Complete UM activities within team specific productivity guidelines.

Care Coordination

Participate in inter-agency/team meetings, treatment planning, and crisis consultations.
Facilitate member-centered collaboration with natural supports, providers, and system partners, addressing social determinants of health and other barriers.
Dependent on team needs work directly in the community with members/providers 6–15 days per month.

Provider Engagement & Quality Monitoring

Conduct provider or stakeholder meetings (quarterly or more frequently).
Monitor length of stay, progress toward treatment goals, and provider performance.
Document quality concerns and collaborate with internal departments to address trends.

Clinical Consultation & Team Collaboration

Consult with Physician Advisors, Psychologist Advisors, and Clinical Supervisors.
Participate in clinical case consultation, supervision, and department meetings.
Support onboarding and department coverage as needed.

Documentation & Compliance

Maintain accurate and timely documentation consistent with agency and industry standards.
Use data to inform clinical decisions and support provider accountability.
Respond to correspondence within 24–48 hours or sooner when necessary.
Maintain a daily log of work and participate in audits, reviews, or site visits.
Completion of required training.

System Knowledge & Advocacy

Demonstrate working knowledge of behavioral health systems, service continuums, and Evidence-Based Practices (EBPs).
Advocate for members to receive care in least restrictive, recovery-oriented settings.
Uphold standards of customer service, family-driven care, and cultural humility.

Position Qualifications

Education:

Master’s degree in Social Work or related clinical field required.

Licensure/Certification:

Licensed Social Worker (LSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), or Licensed Clinical Social Worker (LCSW) preferred.
Candidates without clinical licensure must be eligible and willing to obtain full clinical licensure. If eligible for an associate license, must be obtained within 90 days of hire. Full licensure must be obtained within 18 months of hire.
PA Child Abuse Clearance required.

Experience:

Minimum of 3 years of direct clinical experience providing behavioral health services to children, adolescents, and/or adults. This experience can be inclusive of practicum time and clinical experience pre-master's degree.
Demonstrated experience in assessment, treatment planning, and interdisciplinary care coordination.
Experience providing or overseeing services and/or managed care navigation preferred.

Technical Skills:

Proficient in Microsoft Office, especially Excel, and able to type at least 40 words per minute.
Strong documentation and clinical writing skills.

Core Competencies:

Excellent clinical case conceptualization and proactive planning skills.
Strong facilitation skills for team meetings, trainings, and care conferences.
Ability to work both independently and collaboratively across teams.
Exceptional interpersonal, verbal, and written communication skills.
Familiarity with psychotropic medications and evidenced based behavioral health interventions.
Demonstrated flexibility, strong time management, and the ability to multi-task in a fast-paced environment.
Commitment to professional ethics and compliance with HIPAA and other regulatory standards.

Work Conditions (including travel, overtime required, physical requirements and occupational exposure):

Must be able to travel frequently In Philadelphia and surrounding counties.
Out-of-state travel may be required occasionally.
Regularly requires walking, standing, stooping, bending, sitting, reaching, pushing, pulling and/or repetitive wrist/hand movements for various lengths of time throughout the day.
Ability to utilize computers and office equipment to complete daily work responsibilities.
Regularly works inside in areas that are adequately lighted and ventilated. Some fluctuation in temperature. No protective equipment is routinely needed.
Must be able to adapt to continuous changes/demands of the job.

We Offer:

Family Planning, Fertility, Adoption Benefits
Flexible work hours and work from home opportunities
403B Retirement Plan
PTO Days/Sick Days/Wellness Days
Education Assistance
Wellness Program
Employee Assistance Program
Health, Dental, Vision Insurance
Medical, Prescription Drug Insurance
Commuter Benefits
Flexible Spending

Philadelphia Residency Requirement:

The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.

U.S. Authorization Requirement:

CBH does not provide sponsorship for applicants requiring future work authorization. All candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future.

Equal Employment Opportunity:

We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CBH is an equal opportunity employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on all qualified individuals. This is without regard to race, ethnicity, creed, color, religion, national origin, age, sex/gender, marital status, gender identity, sexual orientation, gender identity or expression, disability, protected veteran status, genetic information or any other characteristic protected individual genetic information, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal, state, or local law.

Requesting An Accommodation:

CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed. If you are hired by CBH and require an accommodation to perform the essential functions of your role, you will be asked to participate in our accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodation once hired.
If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance, please send us an email at CBH.Recruitment@Phila.gov