Clinical Care Management Specialist - Fidelity Wrap svs

The Clinical Care Manager (CCM) Specialist
- Childrens Complex Care (High-Fidelity Wraparound) is part of a specialized team, responsible for providing high intensity care management, that works collaboratively and directly with members and providers to ensure effective, holistic, member-centric care. As a member of CBHs Complex Care team, training and certification in High-Fidelity Wraparound, an evidence-based care management intervention, will be provided.

The CCM Specialist will also be responsible for utilization management by conducting utilization review activities, population management, cross-system consultation, and treatment quality monitoring. As a member of the Childrens Complex Care team, you will have an opportunity to apply your understanding of behavioral health and your cultural competence to work collaboratively with CBH members, their caregivers, their supports, other professionals, and community partners to screen/assess, and develop individualized, family-anchored, comprehensive, and strength-based plans of care.

The CCM Specialist must utilize clinical knowledge of best practices and evidence-based treatments to ensure CBH members receive timely access to quality, medically necessary behavioral health services. When clinically indicated, CCM Specialists consult with CBH Physician and Psychologist Advisors to ensure the most effective treatment for the CBH member is being authorized.

As a High-Fidelity Wraparound (HFW) Facilitator, the CCM Specialist assists members and their families in learning to accomplish goals they have identified by exploring the strengths and culture around each need they have. The CCM Specialist facilitates monthly interagency planning meetings to assist the member and their family in planning around and working towards meeting their needs. The CCM Specialist will transfer their Wraparound skills to the member and their family, by teaching them to think outside of the box and use natural and community supports.

Essential Functions:

• Work directly with members, natural supports and providers in the community, including in members homes.
• Facilitate care coordination. Using an inter-generational approach, with system partners to address social determinants, barriers to wellness, and other needs of members, including connection to appropriate community - based services.
• Create and maintain a team of system partners and natural supports for each member and their family.
• Complete an effective Crisis Prevention Plan in collaboration with each assigned member and their team
• Be knowledgeable about behavioral health care services, system partners, service continuum and established medical necessity criteria and apply that knowledge in all work activities.
• Attend up to 3 hours of group or individual skills-based coaching/supervision per week
• Complete Utilization Management activities including but not limited to: interagency meetings, social determinants interviews with members, treatment team meetings, case consultations, care coordination, provider meetings, reviews, treatment linkage, within established time frames.
• Authorize treatment when Medical Necessity Criteria is met.
• Consult with Physician Advisor, Psychologist Advisor and/or Clinical Leadership as clinically appropriate.
• Generate denial letters based on physician reviews and in accordance with state regulations as needed.
• Demonstrate an understanding of Evidence-Based Practices (EBPs) and connect members to appropriate evidence-based treatment.
• Collaborate with other CBH departments to ensure quality of care, promote placement of members in the most appropriate services and to facilitate consistent longitudinal care management.
• Document provider quality concerns in accordance with CBH policy/procedure.
• Use data to inform clinical decision-making.
• Maintain documentation in CBHs electronic system consistent with agency and industry standards.
• Respond to care coordination correspondence within 24-48 hours or sooner if necessary.
• Attend all meetings as assigned and actively prepare for and participate in supervision and clinical case consultations.
• Ensure the highest quality of customer service when interacting with members, providers, and other stakeholders.
• Display commitment to member/family-driven care and principles of resiliency and recovery.
• Contribute to projects and other duties as assigned.

Team Specific Responsibilities:

• Facilitate monthly interagency HFW Planning Meetings (includes youth/family participation) for a caseload of approximately 10 members and their families.
• Write, revise and distribute individualized Wraparound Plans and Discovery documents to members teams monthly.
• Ensure that the principles and steps of the High-Fidelity Wraparound process are delivered with the highest possible fidelity.
• Provide evidence-based intensive care management interventions directly to members in the community.
• Maintain a care management caseload of approximately 10 members (or as otherwise directed).
• Facilitate care coordination with…