Care Monitor UM, Yonkers, New York
UPMC - Pittsburgh, PA

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Community Care Behavioral Health is hiring a Full-Time Care Monitor UM, New York CCB to help support the CareMgmtSat-Yonkers Department for its Yonkers, New York location.

A care monitor is responsible for interventions with providers who treat seriously ill consumers identified as at risk for readmission, discontinuous care, or those with priority or special needs. The care monitors also perform concurrent reviews with providers who are currently hospitalized. These consumers may present complex needs and may require coordination of their behavioral health services with other aspects of their care. The care monitor is responsible for assessing consumer engagement vis a vis providers, and ensure strong treatment planning and discharge planning processes. The care monitor will utilize claims based data to contact the treating or last known provider. Based upon provider report, the care monitor will perform a concurrent review, discharge review, and will coordinate care for those consumers most at risk. The care monitor executes these responsibilities consistent with the applicable Community Care and NY local government, OASAS, and OMH Policies and Procedures. A care monitor represents the organization to providers, government representatives, oversight entity, and other stakeholders and participates in the overall administration of clinical operations as warranted.

A care monitor is expected to bring a level of clinical leadership to the care management department. Thecare monitors are specifically chosen based upon a targeted area of practice, supported by education, training, experience, and licensure, with expertise in the delivery of behavioral health care to a given population. In addition, a care monitor may serve as the care management lead for other consumers within specific cohorts.

Responsibilities

-Assumes responsibility for a designated client case load specifically selected to match his/her area(s) of practice
-Works as part of a team providing clinical expertise and knowledge to the other consumers of the team
-Conducts all clinical reviews and care coordination (or oversight and supervision) with designated providers for all assigned consumers receiving targeted behavioral health services
-In conjunction with providers and other stakeholders, develops specific outreach plans for assigned consumers who do not maintain regular contact with their behavioral health provider as recommended which may contribute to frequent crises, readmission, engagement difficulties, and lack of maximum benefit from available care
-Maintains an understanding of behavioral health benefits and services and remains current on local mental health benefits and policies and procedures, in regards to services.
-Supervises collection of information regarding the delivery and outcomes of services to consumers, and uses that information to recommend modifications to treatment plan, discharge plan, or service plan which improve the delivery of services to consumers.
-Provides providers, and other stakeholders with accurate information concerning behavioral health care
-Works with providers to customize services to best meet consumer needs within the scope of Community Cares obligations
-Works with regional staff to assure that systematic revisions to improve services are developed and implemented.
-Receives and responds to complex and crisis calls
-Coordinates, reviews and maintains daily logs for reporting purposes and for weekly preparation and analysis of trending reports.
-Assists with coordinating information and making presentations to participating providers, state and federal agencies, community groups and other interested parties
-Facilitates linkages between primary care and behavioral health providers including health homes
and other social service or provider agencies as needed to develop and coordinate service plans
-Collaborates with providers and others in order to obtain initial assessment, treatment planning and aftercare planning for consumers
-Encourages coordination of care with primary care physician and other service providers integral to the consumer┬┐s needs
-Monitors and evaluates effectiveness and outcome of treatment and service plans and recommends, modifications as necessary to provide optimal clinically appropriate services with a goal of maintenance in the community at the least restrictive level of care.
-Coordinates, consults with, and refers to the Medical Director and professional advisors when needed
-Attends case conferences, interagency and provider treatment planning meetings for assigned consumers
-Utilizes supervision with medical director and clinical manager regularly
-Consults with appropriate physician advisors as needed for case collaboration and care planning
-Identifies provider issues and recommendations for improvement
-Lends clinical expertise to other care management staff
-Participates in CQI activities and provider education and training
-Participates in professional development activities
ACCOUNTABILITIES:
-Independent problem solving based on advanced-level knowledge of the service delivery system, the provider network, policies, consumers┬┐ rights and responsibilities, and the operating practices of the organization
-Excellent clinical skills with sophisticated understanding of the over-all needs of individual consumers assigned to him or her
-Ability to propose and implement creative solutions to member problems and to achieve a high level of member satisfaction with services.
-Excellent clinical, written and oral communication skills.
-Responsiveness to deadlines and has work completed on or before deadline 95% of the time.
-Demonstrated knowledge of clinical treatment and case management.
-Knowledge of Community Resources.
-Ability to operate computer software with 95% accuracy.
-Completes a minimum of 25 utilization reviews/ per day
-Must have the ability to travel throughout the 16 counties of the Hudson River Region to ensure that coordination of care for high need consumers is met; and that face to face contact with stakeholders occurs as needed.
-May have work at home options, as stated in policy, with the understanding that travel is required as clinically appropriate.

Basic Qualifications

-Masters degree in human service field.
-Licensed professional with 3-5 years behavioral health clinical experience.
-Experience in inpatient MH; inpatient detoxification or inpatient rehab.
-Specific experience with targeted population including inpatient drug and alcohol, inpatient. adult mental health, or inpatient child mental health.
-Supervisory or other leadership experience in behavioral health also preferred.
-General knowledge of best practices in behavioral health, emphasizing work with special needs or priority populations and in public sector systems.
-Familiarity with Medicaid programs at the state and local level.
-General knowledge of managed care functional areas, including terms and definitions.

Licensure/Certifications

-NY State Licensure.
-CASAS certification if history of drug and alcohol experience/background.

Salary Range:

24.06

32.06

40.07

UPMC is an equal opportunity employer.

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