Community Behavioral Health

Manager

• The Clinical Care Manager (CCM) is responsible for delivering integrated, whole person care management to individuals with complex behavioral needs.
• The CCM facilitates care coordination across multiple systems, ensures timely utilization management (UM) activities, and promotes collaboration between providers, members, and support systems to improve health outcomes.
• Clinical Care Managers are assigned to specific teams based on population needs and service settings, with some responsibilities tailored to those contexts.
• Utilization Management (UM): Review and assess service requests in accordance with Medical Necessity Criteria and regulatory requirements. Actively monitor course of treatment ensuring high quality whole person care. Document UM activities in electronic systems and generate denial letters when applicable. Conduct discharge reviews and concurrent reviews as assigned. Complete UM activities within team specific productivity guidelines.
• Care Coordination: Participate in inter-agency/team meetings, treatment planning, and crisis consultations. Facilitate member-centered collaboration with natural supports, providers, and system partners, addressing social determinants of health and other barriers. Dependent on team needs work directly in the community with members/providers 6–15 days per month.
• Provider Engagement & Quality Monitoring: Conduct provider or stakeholder meetings (quarterly or more frequently). Monitor length of stay, progress toward treatment goals, and provider performance. Document quality concerns and collaborate with internal departments to address trends.