JOB TITLE: COUNTY CARE MANAGEMENT MANAGER

JOB CODE: L0761

DEFINITION: This is professional work assessing and certifying the need for mental health and substance abuse services within the guidelines and standards of the HealthChoices Behavioral Health Managed Care Program in a county Behavioral Health-Managed Care Organization (BH-MCO). An employee in this job reviews demographic and clinical information to authorize and make appropriate referrals to consumers in need of psychiatric and behavioral services or substance abuse treatment services. Work involves providing consumers with information regarding benefits, treatment options, the managed care system, and community resources; maintaining data and client records in an automated system; and reviewing and evaluating the medical appropriateness of psychiatric, behavioral health, and substance abuse cases and, in consultation with supervisor, rendering a certification decision. Work also involves serving as an advocate for consumers and families; facilitating coordination of care with other care managers; completing referral and case documentation in accordance with program standards; conducting follow-up of referrals with consumers and service providers; participating in customer service assessment activities; and preparing reports as mandated by federal, state, or county policies and procedures. Work is performed under the direction of an administrative supervisor and is reviewed through conferences and reports.

EXAMPLES OF WORK: (NOTE: The examples of work are representative of the work, but every position classified to this job may not perform all examples of work listed. Conversely, this is not an all-inclusive list of work examples.)

• Reviews demographic and clinical information to authorize emergency, urgent, or routine referrals to consumers for psychiatric and behavioral services.

• Provides consumers with information regarding benefits, treatment options, the managed care system, and community resources.

• Maintains accurate documentation of all data in automated system and client records.

• Reviews and evaluates the appropriateness of psychiatric, behavioral, and substance

abuse cases and, in consultation with supervisor, renders a certification decision.

• Serves as an advocate for consumers and their families by ensuring they receive the necessary and appropriate clinical services and service referrals that address the social determinants of health.

• Facilitates coordination of care with other care managers to assure continuity and quality of care.

• Completes referral and case documentation in accordance with program standards.

• Conducts follow-up of referrals with consumers and providers of service and participates in consumer service assessment activities.

• Provides required reports as mandated by federal, state, and county policies and procedures.

• Participates in clinical rounds, seminars, and training sessions to maintain licensure and clinical credentials.

• Performs related duties as required.

ENTRY LEVEL KNOWLEDGES, SKILLS, AND ABILITIES:

• Knowledge of the principles and practices of managed care as it relates to behavioral health and drug and alcohol addiction services.

• Knowledge of social, economic, and health problems and resources as they relate to behavioral, psychiatric, and drug and alcohol addiction services.

• Knowledge of the principles and methods involved in providing consultation to consumers in need of behavioral health/psychiatric and drug and alcohol addiction services.

• Knowledge of the structure, organization, and management of the managed care delivery system.

• Knowledge of the principles and methods applied to collecting, reviewing, analyzing, and interpreting information.

• Ability to gather, analyze, and evaluate consumer information related to authorizing and making appropriate referrals to consumers in need of psychiatric and behavioral services or substance abuse treatment services.

• Ability to analyze and interpret legislation, regulations, and policies.

• Ability to communicate effectively orally.

• Ability to communicate effectively in writing.

• Ability to establish and maintain effective working relationships.

MINIMUM EXPERIENCE AND TRAINING: (NOTE: Based on the Entry Level Knowledges, Skills, and Abilities)

• A master's degree in social work, psychology, nursing, or counseling and two years of professional mental health clinical experience;

or

• Two years of professional mental health clinical experience and possession of an active license to practice as a Registered Nurse issued by the Pennsylvania State Board of Nursing.

SPECIAL REQUIREMENTS:

• All positions require an active license issued by the Pennsylvania Bureau of Professional and Occupational Affairs in one of the following areas:

Social Work

20001-Social Worker

20010-Clinical Social Worker

20020-Marrage and Family Therapist

20030-Professional Counselor

Psychology

26001-Psychologist

Nursing

18001-Registered Nurse

18040-Certified Registered Nurse Practitioner

18170-Clinical Nurse Specialist

Commonwealth Equivalent PSG ST08