Call Center Clinical Specialist

Detroit Wayne Mental Health Authority•Detroit, MI

8d•$77,652 - $98,385•Onsite

About The Position

Under the general supervision of the Call Center Administrator, the Call Center Clinical Specialists are responsible for completing telephonic clinical screenings and assessments to determine eligibility into the public mental health system so that consumers will receive the appropriate level of care.

Requirements

Knowledge of DWIHN policies, procedures and operations.
Knowledge of the DWIHN provider network.
Knowledge of medical and behavioral health practices and terminology.
Knowledge of MDHHS policies, rules, regulations and procedures.
Knowledge of Call Center Operations.
Knowledge of Customer Service practices and principals.
Knowledge of co-occurring and substance use treatment services.
Knowledge of the American Society of Addiction Medicine Patient Placement Criteria (ASAM) and the Federal Confidentiality Regulations, 42 CFR, Part 2.
Knowledge of SUD Policies and Procedures.
Knowledge of various treatment modalities including Opiate Maintenance Treatment (OMT) (and re-authorization of Medication Assisted Treatment (MAT) criteria), case management, chemically-dependent pregnant women, co-occurring individuals, SMI/SED and I/DD populations.
Knowledge of women specialty services requirements.
Knowledge of priority population admittance.
Knowledge of State Disability Assistance (SDA).
Knowledge of Intravenous Drug User (IDU) management.
Knowledge of and ability to use screening and assessment tools for behavioral health services.
Knowledge of and ability to use treatment planning, case management and continuing care for behavioral health services.
Knowledge of documents / regulations that govern the provision of mental health services, e.g., Medicaid Manual Mental Health and Substance Abuse Chapter III, State Plan for Medicaid, Michigan Department of Health and Human Services Quality Plan, BBA requirements and the Mental Health Code.
Knowledge of the practices and principles of psychological, emotional, and sociological assessment and diagnosis.
Knowledge of diagnostics, psychopharmacology, and supportive treatment approaches as applied to a severely mentally ill (SMI) adult population.
Knowledge of the identification and treatment of co-occurring mental health and substance use disorders.
Knowledgeable of psychotropic medications.
Knowledge of Pre-Admission Review (PAR) Screening.
Computer skills
Time management skills
Organizational skills
Critical thinking skills
Decision Making skills
Customer Service skills
Language skills
Listening skills
Relationship building skills
Teamwork skills
Training skills
Ability to communicate orally.
Ability to communicate in writing.
Ability to work effectively with others.
Ability to work with an ethnically, linguistically, culturally, economically and socially diverse population.
Judgement/Reasoning ability.

Responsibilities

Determines appropriate levels of care for referral, assisting clients in selecting appropriate service providers.
Initiates referrals to selected providers.
Provides re-authorization of SUD/Mental Health/co-occurring services.
Assists providers with additional client information to provide appropriate referral for treatment services.
Evaluates clinical appropriateness for consumers.
Establishes funding eligibility.
Applies priority status criteria for placement.
Conducts follow-up with clients who were admitted for treatment to assist them with a continuum of care.
Monitors client’s compliance with services and assists with aftercare/recovery plan services.
Reviews requests for authorizing/reauthorizing medically appropriate services and length of stay.
Manages client care through the MH-WIN system.
Provides community callers with information related to community resources and assists callers with information on how to access community services.
Utilizes computer to perform clinical and administrative job functions.
Ensures that consumers are authorized for interventions that meet medical necessity and are least restrictive.
Works collaboratively with providers, health home teams, and community agencies.
Proposes alternative and creative Care Plans when progress is stalled.
Participates actively in program enhancements and the QI program.
Conducts data gathering, documentation and analysis.
Applies Medical Necessity Criteria for Behavioral Health services and applicable standardized assessments, i.e., Level of Care Utilization of System (LOCUS), Supports Intensity Scale (SIS), American Society of Addiction Medicine Patient Placement Criteria (ASAM), Autism Diagnostic Observation Scale Second Edition (ADOS-2), Autism Diagnostic Interview - Revised (ADI-R), Developmental Disabilities - Clinical Global Impression Severity Scale (DD-CGAS), as well as other medical necessity tools and the Federal Confidentiality Regulations, 42 CFR, Part 2.
Conducts initial and ongoing review of enrollee’s clinical condition both behavioral and physical.
Communicates with medical and behavioral providers regarding treatment planning.
Communicates with medical and behavioral providers regarding clinical and psychosocial needs.
Ensures that the reauthorizations database is continuously updated and reflects the current status of individuals in treatment.
Tracks and monitors cost factors relative to service utilization, treatment activities, and other access and placement criteria.
Enters data and reports into written formats and electronic databases.
Monitors provider services for adherence to priority Federal, State and Medicaid admission requirements.
Identifies trends at the provider and network level and submit suggestions for clinical training and or technical support.
Reviews behavioral assessments, diagnostic reports and treatment plans to assess the appropriateness of the authorization request.
Performs related duties as assigned.