Clinical Manager of Case Management Behavioral Health at Independence Blue Cross LLC in Philadelphia, Pennsylvania

Job Description:

Job Summary:

The Manager provides leadership and oversight of the day-to-day activities of the BH case management team(s).  They guarantee effective case management activities are consistently applied and achieved.   The manager is responsible for ensuring  staff     evaluate   member’s clinical condition for both physical and behavioral health through a collaborative approach on care plan development and coordination with members and member’s care team.  This position collaborates effectively with managers within physical health case management unit to ensure an integrated approach between behavioral and physical health.  Is accountable to hire and develop top talent into all levels of positions within the BH unit, strive to meet or exceed unit department goals, ascribe to quality management principles.   

 

Key Responsibilities:

• Oversees the BH staff performing case management provides leadership and ensuring operational goals are achieved.

 

• Proactively identifies opportunities for improvement to the director including but not limited to, changes to BH stratification rules, process changes that promote an integrated PH and BH model, engagement with BH vendors and providers.

 

• Supports and maintains methods for case coordination between departments so referrals between PH and BH are coordinated without fragmentation.

 

• Provides day to day management, counseling, team building, staff development and support required to build and maintain cohesive and effective operations. Ensure all Human Resources department policies and procedures are enforced.

 

• Serves as resource for staff to answer policy/procedure questions and to assist with the resolution of difficult inquiries regarding care delivery.  In addition, maintains the responsibility of ensuring staff use established case   management standards of practice, working to communicate effectively with all members and other internal and external resources.

 

• Monitors call and case activity to ensure staff interactions with members are focused on identifying barriers and achieving member case goals.

 

 

• Ensures that new employees follow appropriate case  management processes and policies and works to develop appropriate skill levels in all associates. Provides coaching and education to the BH Case Managers of department resources and guidelines to improve critical thinking and decision-making capabilities.

 

• Contacts members  and care team when needed  in   complex BH and Medical situations requiring higher level management intervention 

 

• Assured compliance with all legislative and accreditation standards including NCQA, Department of Health (DOH), FEP, CMS and Department of Labor

 

• Participates in evaluation of policies and procedures and makes recommendations for improvement to service efficiency and quality of care.

Qualifications:

Education:

Active PA Registered Nurse License required ( B.S.N. Preferred) or LSW, LCSW, LPC 

 

 

Experience, Knowledge, & Skills:

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    • Five (5) plus years behavioral health, psychiatric and/or substance abuse health care setting    experience    
    
    
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    • Three or more years      previous supervisory/leadership experience is required.   
    
    
    
    
  
  
  
  

 

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    • Team player - builds team spirit and interdepartmental rapport, using effective problem solving and motivational strategy.
    
    
    
    
  
  
  
  

 

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    • Change agent - promotes new ideas and methods; thinks outside the box, creates, and acts on new opportunities; is flexible and adaptable.
    
    
    
    
  
  
  
  

 

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    • Exceptional communication, problem solving, and interpersonal skills.
    
    
    
    
  
  
  
  

 

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    • Action oriented with strong ability to set priorities and obtain results.
    
    
    
    
  
  
  
  

 

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    • Acts as a resource for department, using focused professionalism and effective interactions.
    
    
    
    
  
  
  
  

 

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    • Committed to total quality management and process improvement.
    
    
    
    
  
  
  
  

 

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    • Embrace the diversity of our workforce and show respect for our colleagues internally and externally.
    
    
    • Excellent organizational planning and prioritizing skills.
    
    
    
    
  
  
  
  

 

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    • Ability to effectively utilize time management.
    
    
    
    
  
  
  
  

 

• Proficiency utilizing Microsoft Word, Outlook, Excel, SharePoint, and Adobe programs.  Ability to learn new systems as technology advances.

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