Clinical Specialist - Adult Initiatives

Detroit Wayne Integrated Health Network•Detroit, MI

5d•Onsite

About The Position

The Clinical Specialist works under the supervision of the Director of Adult Initiatives or an Administrator and provides monitoring and clinical oversight of services delivered by DWIHN’s contracted provider network. The role ensures that physical and behavioral health services are implemented in accordance with DWIHN and Michigan Department of Health and Human Services (MDHHS) contractual obligations. As part of a multidisciplinary team, the specialist helps ensure beneficiaries receive services at a clinically appropriate level of care. The position primarily focuses on Clubhouse and Evidence-Based Supported Employment (EBSE) programs and works in the Clinical and Practice Improvement Department. The specialist develops and maintains policies and procedures, provides education and technical assistance to providers, monitors program implementation and performance, and supports compliance, quality improvement, and integrated care initiatives. The role also engages with members, providers, internal departments, and community stakeholders to address concerns and improve service delivery. Work is usually performed in an office setting and requires driving to different sites throughout Wayne County and the State of Michigan.

Requirements

Master’s degree in Social Work, Psychology, Counseling, Human Services, Social Services, or a related field.
Three years of professional clinical experience in public mental health or a behavioral health setting.
Experience providing services to children and adults with severe emotional disturbance; children and adults with intellectual and/or developmental disabilities; adults with mental illness; and/or individuals with substance use disorders.
Valid State of Michigan clinical licensure: RN, LMSW, LMHC, LPC, LLP, or PhD.
Valid State of Michigan driver’s license with a safe and acceptable driving record.
Knowledge of DWIHN policies, procedures, and practices; the DWIHN provider network and community resources; the Michigan Mental Health Code; and MDHHS policies, rules, regulations, and procedures.
Knowledge of medical and behavioral health practices and terminology, compliance standards, governing mental health service documents and regulations, regulatory and industry best practices, CMHSPs and PIHPs, integrated care, HAB Waiver requirements, the adult I/DD provider network, and the continuum of care for disability designations including I/DD, SED, SMI, and co-occurring disorders.
Knowledge of the practices and principles of psychological, emotional, and sociological assessment and diagnosis.
Ability to use multiple technology systems and computer skills.
Time management, organizational, critical thinking, teamwork, conflict resolution, problem-solving, decision-making, negotiation, project management, assessment, report writing, communication, multitasking, analytical, adaptability, and interpersonal skills.
Ability to communicate orally and in writing, work effectively with others, and work with ethnically, linguistically, culturally, economically, and socially diverse populations.
Judgment and reasoning ability.

Responsibilities

Develop and maintain policies and procedures consistent with MDHHS requirements and Clubhouse and EBSE program fidelity standards.
Provide education, training, and technical assistance to network providers and contractors on policies, procedures, standards, and service requirements.
Coordinate and facilitate recurring meetings with Clinically Responsible Service Providers (CRSPs) to support communication, service utilization, and reporting compliance.
Ensure compliance with HIPAA requirements for submission and management of member data.
Collaborate with Customer Services and the provider network to address and resolve member satisfaction concerns.
Work with Recipient Rights on grievances, appeals, denials, and related member issues.
Facilitate and attend stakeholder meetings, community forums, and educational sessions concerning network policies and procedures.
Partner with the Adult Initiatives Director or Administrator to evaluate and improve member satisfaction related to service delivery.
Collaborate with the Access and Call Center on eligibility criteria, disability designations, service referrals, and care coordination processes.
Provide clinical oversight of CRSP contracts and implementation of integrated physical and behavioral health services across the provider network.
Oversee accredited Clubhouse psychosocial rehabilitation programs and EBSE programs, ensuring regulatory and fidelity compliance.
Monitor program performance, utilization trends, and service outcomes to identify improvement opportunities and ensure compliance with organizational standards.
Collaborate with the Quality Department on network adequacy initiatives and Performance Improvement Plans related to audits, accreditation reviews, and quality improvement.
Partner with the Integrated Health team to advance physical health integration initiatives across the provider network.
Develop, analyze, and interpret clinical and operational reports to identify utilization patterns, service trends, performance gaps, and improvement opportunities.
Use data-driven decision-making to develop corrective action plans and performance improvement strategies for providers that do not meet standards.
Provide technical consultation, guidance, and monitoring to CRSPs on access to care, service coordination, utilization management, and compliance.
Ensure ongoing implementation and monitoring of evidence-based and best-practice models, maintaining fidelity and quality standards.
Participate in multidisciplinary teams to evaluate service needs and ensure individuals receive clinically appropriate levels of care.
Provide clinical leadership and oversight for behavioral health and integrated care initiatives within the DWIHN provider system.
Collaborate with internal departments and contracted providers to support compliance with accreditation, audit, quality management, and behavioral health service standards.
Promote person-centered service delivery and continuous quality improvement across the behavioral health provider network.
Perform other related duties as assigned.