Clinical Care Manager - Specialty Pop.

The Specialty Populations Clinical Care Manager (CCM) is responsible for longitudinal care management and clinical oversight of members with complex behavioral health needs residing in high acuity and long-term residential settings. These settings include Extended Acute Care, Non-Hospital Extended Acute Care, Residential Treatment Facility for Adults, Long Term Structured Residences, Integrated Behavioral Health in Long- Term Care and Community Treatment Team – Clinically Supportive Living.

This role ensures clinically appropriate and person-centered care through ongoing utilization management, provider collaboration, and system coordination. The Clinical Care Manager actively supports discharge planning, reduction of prolonged lengths of stay, and transitions to the least restrictive level of care, while addressing clinical, social, and legal barriers impacting member outcomes.

Essential Functions

• Deliver longitudinal, integrated care management for assigned members across levels of care and systems.
• Apply knowledge of behavioral health systems, service continuums, and medical necessity criteria in all clinical and administrative activities.
• Collaborate with members, natural supports, and providers in communities, hospitals, and virtual environments.
• Ensure Providers are using Evidence-based Practices in treatment planning for members.

Team - Specific Functions

Specialty Populations Care Management Team

• Complete 8 -15 UM activities per day.
• Conduct care coordination to support collaboration with system partners.
• Participate in case reviews, provider meetings, and interagency discussions.
• Review and process referrals for residential levels of care.
• Support resolution of cross-system barriers impacting member care.
• Manage a caseload of members with prolonged lengths of stay, communication, or accessibility needs,
• Identify systemic and individual barriers impacting care progression.
• Initiate and maintain discharge planning at admission, with ongoing updates throughout the length of stay.
• Identify and address barriers to discharge, including clinical stabilization, housing availability, legal or forensic restrictions, and independent living skill deficits.
• Collaborate with providers to develop actionable and realistic transition plans.
• Facilitate movement to lower levels of care when clinically appropriate.
• Ability to engage with members and providers onsite at provider location.
• Other duties as assigned

Position Qualifications

Education:

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

Licensure:

• PA Child Abuse Clearance required
• Clinical Licensure: Qualified candidates are required to obtain a ( LCSW, LPC & LMFT) within 2 years of employment. LSW must be obtained by 9 months of employment.
• Required Licensure: Licensed Social Worker (LSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW)

Experience:

• Minimum of 3 years of direct clinical care experience working with adults, children, adolescents, and/or their families in behavioral health settings.
• Experience in assessment and treatment planning required.
• Experience in managed care or utilization management preferred.
• Prior experience in residential settings strongly preferred.

Core Skills & Competencies:

• Excellent clinical case conceptualization and treatment planning skills.
• Strong communication skills, both verbal and written, with ability to collaborate across systems.
• Excellent interpersonal and collaboration skills.
• Ability to facilitate care team and interagency meetings.
• Familiarity with medications and behavioral health terminology.
• Strong customer service orientation.
• Proactive planning and organizational skills.
• Proficient in Microsoft Office (especially Excel); ability to type 40+ words per minute.
• Strong time management skills; ability to multi-task and work independently or as part of a team.
• Compliant with HIPAA and applicable clinical documentation standards.
• Skills in conflict resolution, engagement, and clinical supervision/oversight of care coordination are essential.

Philadelphia Residency Requirement:

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

Equal Employment Opportunity:

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