PartnersACCESS Specialist (QP) Remote-NC (PRN)

Partners Behavioral Health Management•Morganton, NC

11h•Remote

About The Position

This position provides the initial screening, referral and or scheduling of members who call the toll-free PartnersACCESS Member Services number seeking health and behavioral health services. As appropriate, the position will transfer the member to a clinician who will clinically triage/assess the member’s acuity and determine what type and intensity of service the member needs and/or is eligible to receive.

Requirements

Sound knowledge of health/MH/SU/TBI/I/DD for the appropriate determination of eligibility for Medicaid and State supported services, appropriateness of referrals for treatment and assessment and the level of danger of the members calling for assistance.
Knowledge of the laws governing the treatment of health, mental illness, substance abuse and intellectual/developmental disabilities as well as the resources available in the community for treatment.
Knowledge of call center functions, member population, potential for crisis issues, confidentiality laws and program protocols/policies.
Excellent computer skills.
Ability to complete tasks independently, define problems, apply laws, policies and procedures to agency activities and must use sound judgment in conducting screening, triage and referral.
Ability to use sound judgment when conducting a screening and be able to determine when it is necessary and appropriate to transfer a member to a Licensed Access to Care Clinician.
Ability to communicate effectively orally and in writing, have good keyboarding skills and be able to multi-task (that is: converse while entering screening information into the electronic medical record and evaluating the member’s need).
Ability to take highly complicated criteria and apply it to cases in determining eligibility for services and appropriate scheduling referrals.
Ability to assist members in highly stressful situations which may be life threatening to the member or public while at the same time facilitating a connection to crisis services and/or a Licensed Access to Care Clinician.
Ability to provide technical assistance to both members and Providers.
Ability to maintain confidentiality when screening and referring calls/callers.

Nice To Haves

Licensed practical nurses (LPNs) and at least four (4) years of healthcare and/or MH/SU/IDD experience.

Responsibilities

Initial screening of Health/Mental Health (MH)/Substance Use (SU)/Traumatic Brain Injury (TBI)/Intellectual/Developmental Disability (I/DD) treatment needs, benefit information and referral of members calling to determine if they may potentially qualify for services.
Collect and enter demographic data into the electronic record, completion of appropriate forms, explanation of services, benefits and resources, verifies Medicaid and dispatch.
Provide follow up calls to referral sources and members to ensure that members have been successfully engaged in services.
Make referrals to clinical homes and crisis providers that meet the timeliness standards as defined by NC Medicaid.
Provide information about local community resources, independent practitioners, and related providers for referrals for basic benefit services.
This position demands a high level of accuracy and confidentiality. Information must be handled according to NC standards and rules, state and federal laws and LME/MCO and NCQA standards, procedures, policies and protocol.
Assists with authorizations/admissions to state hospitals, ADATC, Three Way Hospitals, Level III Detox, Facility Based Crisis and all referrals to crisis services.
Process other acute care authorizations as requested by supervisor or other Access to Care Licensed Clinician.
Screenings are completed using standard and specialized computer programs.
Inputs accurate information into the system and unlocks electronic service records with appropriate consents, enters all necessary data elements into data systems.
Provide technical assistance to First Responders, clinical home providers, and Mobile Crisis Management.
Establish and maintain effective working relationships within the unit, agency, and service system.
Consistently demonstrate professionalism, tact and diplomacy in handling irate callers and/or working with contract providers and other external parties.
Participate in Unit Staff meeting, Agency Staff meetings, (All staff meetings) and assigned committees.