Clinical Specialist Performance Monitor

Detroit Wayne Mental Health Authority•Detroit, MI

14h•Hybrid

About The Position

Under the general supervision of the Quality Administrator, Performance Monitoring, the Performance Monitor staff is responsible for conducting on-site reviews of providers and ensuring their compliance with quality and performance standards among contracted Substance Use Disorder (SUD) treatment providers. This role emphasizes monitoring provider adherence to regulatory requirements, contractual obligations, and evidence-based practices to improve outcomes for individuals receiving SUD services.

Requirements

Knowledge of DWIHN policies, procedures, and practices.
Knowledge of the principles of quality improvement.
Knowledge of Utilization Management
Knowledge of Quality Assurance.
Knowledge of the DWIHN provider network.
Knowledge of medical, behavioral health, and SUD practices and terminology.
Knowledge of compliance standards.
Knowledge of the evidence-based practices for prevention, treatment, and recovery support services for mental and substance use disorders.
Knowledge of MDHHS policies, rules, regulations, and procedures.
Knowledge of Medicaid policies, rules, regulations, and procedures.
Knowledge of the NCQA accreditation process.
Knowledge of HSAG annual compliance reviews.
Knowledge of Integrated Care principles and practices.
Knowledge of Health and Safety and Claims Investigations.
Knowledge of Behavior Treatment Plans, IPOS, Medication Administration, and Incident reporting.
Assessment skills.
Organizational skills.
Planning skills.
Analytical skills.
Report writing skills.
Decision-making skills.
Interpersonal skills [https://zety.com/blog/interpersonal-skills].
Communication skills
Teaching skills.
Training skills.
Coordination skills
Written communication skills
Investigation skills.
Computer skills (Word, Excel, Access, Power Point, Outlook, Teams).
Teamwork 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.
A master’s degree in social work, Psychology, Counseling, Nursing (a bachelor’s degree will be accepted), or a related field.
State of Michigan license commensurate with Degree (LLMSW, LMSW, LLP, LP, LLPC, LPC, RN) MCBAP Certification: CAACD, CADC, CPS, or CPC
Must meet credentialing qualifications in at least one of the following: Qualified Mental Health Professional (QMHP), Qualified Intellectual Disabilities Professional (QIDP), Qualified Children Mental Health Professional (QCMHP), or Substance Abuse Treatment Specialist (SATS).
A valid State of Michigan Driver’s License with a safe and acceptable driving record.
Four (4) years of professional experience in a behavioral healthcare or a community mental health setting, including at least 2 two years of experience performing clinical duties and responsibilities, prevention, treatment, or recovery support services for mental and substance use disorders.

Responsibilities

Monitor SUD provides compliance with state, federal, and organizational regulations.
Review provider documentation, billing practices, and service delivery for accuracy and integrity.
Conduct audits and site visits as required.
Track provider performance metrics, including treatment outcomes, timeliness, and member satisfaction.
Identify gaps in service quality and collaborate with providers to implement corrective action plans.
Ensure adherence to evidence-based treatment protocols
Collect and analyze data related to provider performance and compliance.
Prepare reports for leadership summarizing findings, trends, and recommendations.
Maintain accurate records of monitoring activities.
Serve as a liaison between providers and internal departments to resolve issues.
Provide technical assistance and training to providers on compliance and quality standards.
Support continuous improvement initiatives across the SUD provider network.
Designs systems and procedures.
Conducts work simplification and measurement studies.
Prepares operations and procedures manuals.
Sets standards, conducts performance assessments, and conducts remote and on-site monitoring of providers in the network.
Monitors the facility quality improvement process and provides facility provider education and oversight.
Participate in MDHHS audits and site visits.
Oversee new program enrollment and Medicaid Enrollment reviews, which involve site visits to ensure that new programs or programs requiring Medicaid enrollment meet the minimum requirements for participation in the DWIHN network.
Attend SUD and other provider meetings.
Reviews data for trends and creates monthly reporting, including reporting data into the Cascade software database.
Communicate with providers by responding to phone calls, responding to e-mail requests, providing training, and providing technical assistance.
Performs related duties as assigned.