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Community-Based Care Manager for Center of Excellence in Philadelphia, PA at Public Health Management Corporation

Date Posted: 2/11/2019

Job Snapshot

Job Description

Our Mission is to be the premier regional provider of integrated, community-based healthcare by combining evidence-based clinical practices, outstanding patient service, innovative care partnerships, and team-driven excellence, within a healthy fiscal environment.

Community-Based Care Manager (CBCM) sought to work as part of the Opioid Use Disorder (OUD) Medical Home, also referred to as Center of Excellence (COE). This COE has been created by the Commonwealth of Pennsylvania to help address systematic factors that contribute to problematic use of opioids in the community. Duties will include working with a care management team  to accept referrals of individuals with OUD from local emergency departments, state and county corrections facilities, inpatient and outpatient residential substance use providers,  and from primary care providers and helping these individual connect to, and remain supported by, a variety of community resources.  The CBCM will work to motivate and encourage individuals with OUD to stay engaged in both physical health and mental health treatment. The CBCM will be responsible for connecting with new individuals with OUD via outreach to address their care needs, as well as ensure continued engagement of referred individuals with OUD to assist with ongoing care coordination. The CBCM reports directly to the LSW supervisor. This is a full-time position that will require frequent, local travel.

Essential Duties and Responsibilities:  

  • Outreach within target communities and key institutions including, prisons, hospitals, primary care settings, and homeless shelters, to reach adults struggling with opioid use disorder, and connect then to assessments with the COE
  • Providing ongoing support to assigned individuals with OUD and additional needs, to help them access resources that will assist in improving their treatment and daily life outcomes. This includes monitoring at a regular, assigned frequency to assess resource connection and helpfulness, and troubleshooting problems that arise.
  • Consultation with primary care and treatment providers to ensure patients struggling with OUD are fully engaged in care, provide support for treatment planning, and assist in the implementation of evidence based assessments and care connection
  • Productively work to help the COE meet program expectations for outreach and care connection.
  • Participate in a learning network that will include increasing awareness of OUD-related resources and needs; complex case-based learning; and ongoing supervision will occur with the COE team.
  • Partner with Quality Management, LSW, and clinical teams to track and internally report key metrics at an individual and aggregate level.
  • Maintain appropriate records of activities, patients, fidelity, and outcomes

Coordination of Care – Facilitate recovery by helping individuals find stable housing and employment and help them to re-establish family/community relationships. Provide feedback to and coordinate care of patients with health center primary care staff.  Identify, refer, and advocate for patients needing specialty behavioral health service, and other services as needed.

PHMC Compliance Responsibilities:

  • Understands and adheres to PHMC compliance standards as they appear in the PHMC Code of Conduct, Whistle Blowers and Conflict of Interest Policies
  • Keeps abreast of all pertinent federal, state and PHMC regulations, laws, and policies as they presently exist and as they change or are modified
  • Comply with HIPAA and Confidentiality Policies and Procedures as they apply to the job
  • Comply with Department of Public Health (DPH), The Joint Commission and other accreditation and regulatory agencies standards
  • Adhere to all PHMC Policies and Procedures
  • Knowledge and adherence to Infection Control and Environment of Care Guidelines and Procedures as described in the annual education module

Job Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


  • Excellent interpersonal skills; comfort working with diverse populations and in multidisciplinary teams;
  • Ability to maintain client confidentiality; sensitivity to racial/ethnic and economic diversity;
  • Microsoft Office and basic computing skills; ability to complete computer-generated reports.


  • Experience working as a member of an interdisciplinary team
  • Comfort working with diverse populations ( i.e. race, ethnicity, diagnoses, age ranges)
  • Preference is placed on prospective employees who have demonstrated experience in community outreach, working with vulnerable populations (including but not limited to incarcerated individuals, those with substance use and/or mental health conditions), and/or community advocacy in North Philadelphia.


  • Bachelors Degree in Social Work or related field from and accredited school, or Associates Degree in Human Services or related field from accredited school plus minimum three years of related work experience, or equivalent experience.

Physical Demands:

  • Position requires standing 2/3 of the time, walking 2/3 of the time, requires sitting under 1/3 of the time, use of hands to finger, handle or feel 2/3 of the time, reach with hands and arms, under 1/3 of the time, stoop, kneel, crouch or crawl under 1/3 of the time, talk or hear over 2/3 of the time. Position requires lifting up to 10 lbs. up to 1/3 of the time.

Work Environment:

  • Moderate noise (examples: business office with computers and printers, light traffic).  Exposure to blood borne pathogens that requires use of personal protective equipment.


  • Commensurate with education and experience