Residential Coordinator & Provider Network Auditor

Saginaw County Community Mental Health Authority•Saginaw, MI

About The Position

Under the general supervision of the Provider Network Auditing Supervisor, this position provides education and support to all case holders and crisis team members about residential options. The role is also responsible for conducting program audit functions for Saginaw County Community Mental Health Authority (SCCMHA) as part of a compliance and quality performance program to safeguard against fraudulent or erroneous claims of service provision on behalf of SCCMHA. Provides guidance to case holders regarding least restrictive settings based on identified housing needs such as supported independent housing, general foster care, and specialized residential care. Works in collaboration with case holders to identify and secure housing options taking into consideration individual choice and residential service network availability. Collaborates with residential providers to ensure compliance with Home and Community Based Services Rules (HCBS). Works with contracts manager to ensure appropriate contract action is taken when a residential placement is approved. Working with approved regulatory and contractual guidelines and SCCMHA policies, this position will work individually or in a team to initiate, compile, complete, document and analyze audit findings for SCCMHA. Audits both contracted and board operated programs. Verifies event documentation and identifies system deficiencies by provider (i.e., billing code and modifier deficiencies). Reviews provider service delivery records and may conduct contractor compliance reviews. Presents summary information to key SCCMHA management team staff as requested or indicated. Represents SCCMHA to the provider network in monitoring and compliance measurement verbal and written communications. Required to develop in-depth knowledge of service requirements for varied SCCMHA programs. Requires strong leadership skills to effectively lead and communicate with stakeholders. Additionally, this position requires the coordinator to effectively balance both residential placement responsibilities and auditing duties to ensure timeliness and accuracy in all functions. Strong organization and prioritization skills are essential to meet deadlines and maintain quality standards. This position will be knowledgeable about and actively support culturally competent recovery-based practices; person-centered planning as a shared decision-making process with the individual, who defines his/her life goals and is assisted in developing a unique path toward those goals; and a trauma informed culture of safety to aid individuals in the recovery process.

Requirements

Minimum of bachelor’s degree in Health and Human Services, Master’s degree preferred.
Five (5) years’ experience providing support and treatment to individuals with serious mental illness or intellectual and developmental disabilities, or case management experience in mental health service delivery including service to those in licensed residential settings required.
Must have demonstrated public relations, and/or community organization skills.
Must have the ability to work with varied levels of organizations and strong written and verbal communication skills
Valid Michigan Driver’s license with good driving record.
Clinical awareness and sensitivity.
General business and effective writing and editing skills.
Computer competency, including word processing, spread sheets, databases, internet, E-Mail. Advanced computer skills, including all Microsoft applications (Competency testing may be required).
Ability to plan and organize work and provide small group leadership.
Effective oral and written communication skills, minimum at college level.
Ability to organize and maintain data and information.
Problem solving and mediation abilities.
Ability to maintain favorable public relations and provide community leadership.
Ability to exercise independent and mature judgment.
Ability to maintain strict confidentiality. Handles varied confidential or privileged information with discretion and caution.
Ability to work independently.
Hearing acuity to converse in person and on telephone.
Visual acuity to observe persons served behavior, read and proofread documents and use EHR and other electronic devices.
Ability to walk, stand or sit for extended periods of time.
Ability to sit and drive a car for lengthy periods of time.
Manual dexterity to write and to operate standard office equipment (PC, Keyboard, Copy Machine, Fax Machine, etc.)
Ability to lift and carry files and supplies at least 20 pounds.
Strong interpersonal skills to interact with varied providers within the SCCMHA network as well as with other community partners.
Analytical skills necessary to conduct research, analyze, and interpret complex data and identify and solve problems by proposing courses of action.
Ability to plan short and long range and to manage and schedule time.
Ability to handle stress in meeting deadlines and dealing with large numbers of individuals.

Responsibilities

Assist case holders with locating appropriate supports to keep individuals in their current residential living arrangements.
Understands the various residential arrangements and can articulate those to case holders.
Provides support to case holders with residential placements as needed based upon individual specific assessed needs (AFC, CFC, CCI, CL Supports)
Understands Self Determination and can assist staff in how to refer an individual to this benefit model.
Understands the Michigan (MI) Choice Waiver and how this benefit may assist some individuals to be as independent as possible.
Reviews clinical charts and relevant documentation to help determine the best placement for individuals.
Assist case holders and crisis team members as needed with timely discharge planning of individual(s) requiring residential placement from local/state inpatient, long term care settings, or rehabilitation settings.
Conduct on-going monitoring of residential network placement capacity for as-needed recruitment of local child & adult foster care facilities and out-of-county residential services network placement options.
Assist case holders and individuals in identifying and overcoming residential barriers in promoting self-sufficiency in the least restrictive setting possible.
Understands the requirements of Home and Community Based Services (HCBS) rules and assists with education of staff in understanding the rules.
Reviews potential sites for HCBS compliance and coordinates with Mid-State Health Network.
Attends all quarterly HCBS Workgroup meetings with Mid-State Health Network and Michigan Department of Health and Human Services (MDHHS).
Tracks all in-county and out-of-county residential placement referrals and provides updates as requested.
Review and update all HCBS policies and procedures on an annual basis.
Review and provide feedback on the inclusion of the 8 elements for restrictions in the IPOS.
Submits all relevant documentation to Mid-State Health Network when requesting placement in a Heightened Scrutiny Setting.
Chairs Residential Placement Committee and Residential Watch Committee and any sub-committees.
Attend all Clinical Risk Committee meetings.
Is a Member of Quality-of-Life Committee.
Collaborates with the Contracts Department to ensure accurate updates to the residential vacancy list.
Provides on-going training/education to staff about the residential placement process.
Completes Contract Action Forms and submits to the designated supervisor and director for approval.
Help coordinate and attend all Interdisciplinary Team meetings as a representative of the Residential Placement Committee.
Establishes audit samples, basis, schedules and plans with audit team members.
May be assigned specific program types for audit tasks based on experience or SCCMHA needs.
Contributes to audit program development; recommends modifications based on testing or use.
Conducts annual, routine or ad-hoc SCCMHA audits or provider reviews to meet organizational goals.
Identifies areas of deficiency based on audit results, and recommends corrective areas for provider network members, including causation analysis and implementation of preventative actions.
Presents audit findings to providers, including explanation and justification for negative findings and/or audit score levels.
Reviews provider corrective action plans and outcomes for compliance to audit standards and recommends SCCMHA and provide proactive steps for future compliance.
Conducts audits or performance reviews based on consistent, objective standards.
Verifies that service events occurred and are properly documented to support legitimate SCCMHA authorization of funds such as billing codes and staff credential for billing services.
May conduct contract compliance or other provider record audit reviews.
Prepares letters of event verification findings and presents data to be easily reported to MDHHS for annual reporting.
Visits provider programs on-site and reviews all necessary files and documentation for audit purposes.
Establishes audit findings based on documentation and factual materials and presentations.
Interprets and exercises appropriate cautions in the interpretation of audit findings for department or management staff as well as applicable providers.
Alerts Department and SCCMHA management regarding serious, immediate findings.
Alerts the Office of Recipient Rights of any issues that might pertain to a violation of the Michigan Mental Health Code.
Prepares written audit summaries and reports.
Required to meet auditing unit performance standard.
Audit schedule will be contingent on residential placement workload.
Applies compliance, regulatory and quality improvement standards in audit functions and tasks.
Recommends policy or procedural changes as appropriate.
Exercises discretion with provider data and information, including confidentiality.
Recommends audit report formats and forms for SCCMHA use.
Works with department and management leadership, including SCCMHA contract management, finance, operations, clinical services and compliance and quality areas to improve audit program and functional operations.
Stays abreast of provider documentation and organizational compliance requirement changes.
Coordinates work with recipient rights, clinical and management staff.
Maintains current knowledge of system changes that impact audit work, including SCCMHA procedures, business standards, and licensing requirements.
Provide specific supports and educational services to specific providers as indicated or needed to assist with and promote provider compliance.
Actively monitors provider corrective action plans for completion, alerts supervisors of any needed sanctions.
Facilitates persons served involvement in site audits and promotes persons served involvement in provider operations.
Develops samples and other useful provider tools for site implementation to support compliance.
Provides education to staff or providers either one-on-one or in a group setting to clarify audit standards.
Adheres to the mission, vision, core values, and operating principles of SCCMHA at all times.