Provider Case Manager

The Provider Case Manager will focus on streamlining and improving processes, communication, provider satisfaction, and clinical quality outcomes with our network of providers. By conducting consultations with providers and concentrating on clinical outcomes, this role ensures our providers are held accountable to CCS’s clinical standards and requirements by using measurable outcomes to ensure appropriate medical treatment and compliance. By improving provider-specific needs and clinical outcomes, we aim to create a more efficient and supportive partnership.

The Provider Case Manager liaises between the provider network, client families, internal CCS departments, and other resources to assess and coordinate appropriate behavioral health treatment. The Clinical Provider Manager supports coordination of care to ensure that each client receives high-quality services.

Core Responsibilities & Essential Job Functions

• Follows client care plan through effective case management.
• Responsible for assessing and addressing risk, and escalates high risk clinical concerns to supervisor
• Serves as a liaison between treatment providers, funding sources, and client families.
• Serves as the main contact for providers and responds to all provider inquiries; responsible for ensuring provider inquiries are addressed.
• Responsible for conducting service recovery with providers and reviewing appropriateness of provider transfer requests.
• Completes documentation regarding all interactions with the client, provider, and interdisciplinary team, using appropriate systems and procedures in a timely manner, per agency policies.
• Responds to provider related concerns raised by client families
• Responsible for attending quarterly provider meetings, collaborating with Network Support Coordinator, and reviewing provider data and clinical trends.
• Collaborates with the Client Case Manager regarding clinical concerns.
• Supports Clinical Escalation Specialists and Client Case Managers in provider related complaints and grievances by conducting client case reviews or provider outreach.
• Develop and maintain strong, positive relationships with network providers to enhance collaboration and satisfaction.
• Responsible for communicating clear and specific expectations regarding clinical performance and quality outcomes.
• Facilitate clear and effective communication between providers and internal teams.
• Collaborate with providers to identify and implement strategies for improving quality outcomes and client care.
• Monitor and analyze provider performance metrics to ensure clinical alignment and client satisfaction.
• Prepare and present data to management on provider-related outcomes and trends
• Provide guidance and support to providers on clinical protocols, policies, and procedures.
• Participate in special projects, and assist with additional duties or tasks, as assigned by supervisor.

Qualifications

Minimum Education, Experience & Training Equivalent to:

• Master's degree from an accredited college or university in social work, marriage family therapy or counseling is required.
• Current registration as an Associate with the California Board of Behavioral Sciences
• Licensed Clinical Psychologist, LCSW, LMFT or LPCC preferred.
• One to two years of related professional experience working with children with autism spectrum disorders (“ASD”) and/or other related developmental disabilities in a multi-disciplinary team setting preferred
• Knowledge of community resources
• Previous experience of case management.
• Demonstrated expertise in crisis management.
• Proven track record of successful provider relationship management and process improvement.

Knowledge & Skills:

• Must adhere to all federal, state, and local laws/legislations as applicable as well as HIPAA laws and regulatory agencies
• Sensitivity to working with an ethnically, linguistically, culturally, and economically diverse population.
• A commitment to the values of the organization while demonstrating good judgment, flexibility, patience, and discretion when dealing with confidential and sensitive matters.
• Knowledgeable in Microsoft Office (Outlook, Word, Excel, etc.)
• Work in a fast paced environment while effectively multitasking.
• Work comfortably with individuals at all levels within the organization.
• Manage day-to-day responsibilities with or without supervision.
• Excellent verbal and writing skills.
• Strong interpersonal skills.
• Must be highly detail oriented and have strong time management skills.

Physical Requirements:

• Must be able to communicate effectively within the work environment, read and write using the primary language with the workplace.
• Visual and auditory ability to work with clients, staff, and others in the workplace continuously.
• Frequent speaking and listening (25-75%) to clients, staff, and others in the workplace.
• Ability to utilize computer, cell phone (iPhone).
• Frequent sitting.

Conditions of Employment

• Ability to obtain and maintain criminal record clearance through the Department of Justice (DOJ). The People & Performance Department must analyze DOJ/FBI live scan reports in accordance with applicable Federal, State, and Local laws, as well as fitness for the position.
• Ability to obtain and maintain clearance through the Office of Inspector General.
• Ability to obtain and maintain a National Provider Identifier (NPI).
• Must attend any required training.

The statements contained in this job description reflect general details as necessary to describe the principal functions of this job. It should not be considered an all-inclusive listing of work requirements. Individuals may perform other duties as assigned, including work in other functional areas as deemed fit for the organization.