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UPMC Community Care Behavioral Health is seeking a full-time Clinical Associate to support the North Central Children's Care Management team in Moosic, PA!

The Clinical Associate will work daylight hours, Monday through Friday, in a hybrid work structure! This role will primarily be able to work from home, but there will be occasional office time for meetings and other departmental needs.

Community Care Behavioral Health (CCBH) is committed to giving our neighbors the quality of life that they deserve. A proud part of the UPMC Insurance Services Division, CCBH provides members with the behavioral health treatment that they need for better health and a higher quality of life, including treatment for mental health conditions, drug or alcohol addiction, and developmental disabilities.

The Clinical Associate will manage member service-related functions and specific care-related functions for member populations served by Community Care. This role serves as a resource and advocate for members in their interaction with all aspects of Community Care, and also works to ensure accurate information is documented and relayed to team members and providers. Supporting the Children's Services team, the Clinical Associate is "the hub" of the team, responding to member questions, relaying information to providers, facilitating referrals, and supporting activities related to education, outreach, prevention, and clinical record review for members. Additionally, this role will handle tasks supporting the entire contract.

The ideal candidate for this position will have previous clinical experience in a behavioral health setting, specifically working with children's services. The Clinical Associate will work hand-in-hand with Care Managers, working to manage the implementation of procedural modifications, data entry of medical necessity records, the review of overall clinical data, and fostering a strong rapport with providers. Previous experience with case management is also preferred, while exceptional communication and organizational skills are vital to this role.

Responsibilities:

• Conducts outreach as well as assistance with coordination of care for those members who do not maintain regular contact with their behavioral health provider as recommended.

• Provides members, providers, and other stakeholders with accurate information concerning benefits and coverage, including (but not limited to) information about the PH-MCO, IEAP, CART, etc.

• Independently problem solves based on knowledge of in-plan services, the provider network, member services policies, members' rights and responsibilities, and the operating practices of the organization.

• Collects information regarding the delivery and outcomes of services to members.

• Collects data for company initiatives in cooperation with department of oversight (e.g., quality department, provider relations, etc.).

• Coordinates, reviews, and maintains information for reporting purposes and analysis.

• Works with members, providers, and the designated care managers to customize services to best meet members' needs within the parameters of available services.

• Works as an effective member of the care management department and individual team.

• Maintains an understanding of behavioral health benefits and remains current on covered or in-plan services, benefit limitations, exclusions, and care management policies and procedures.

• Executes daily responsibilities with evidence of cultural competency and awareness of CSP, CAASP, and/or BDAP principals, as applicable.

• Identifies provider issues with recommendations for improvement.

• Monitors PA reviews to be completed each day.

• Provides services to customers of Community Care in line with policies and procedures.

• Interacts with county stakeholders to ensure timeliness and action steps.

• Works closely with the care management team on day-to-day tasks.

• Coordinates between Community Care and PH-MCO, as needed.

• Bachelor's Degree in health or human services field WITH progressive clinical experience and responsibility.

• Master's Degree in counseling or social work preferred/a plus.

• Knowledge of managed care functional areas, including terms and definitions.

• Experience in managed care preferred.

• Previous experience working with children's services preferred.

• Case management experience is a plus.

• Knowledge of best practices in behavioral health, including substance use disorders and treatment, emphasizing work with special needs populations and in public sector systems.

• Ability to organize and present information and data to various audiences.

• Possess strong clinical skills and an outstanding working knowledge of the community serving their assigned membership.

• Ability to propose and implement creative solutions to member problems to achieve a high level of member satisfaction with services.

• Strong clinical, written, and oral communication skills.

• Responsiveness to deadlines and has work completed on or before deadline 95% of the time.

• Knowledge of community resources.

• Proficiency in operating computer software.

Licensure, Certifications, and Clearances:

• Act 31 Child Abuse Reporting

• Act 33

• Act 34

• Act 73 FBI Clearance

UPMC is an Equal Opportunity Employer/Disability/Veteran