Therapist - Managed Care Operations - Contract

1 month ago

Clinton Township, United States Macomb County Community Mental Health Full time

GENERAL SUMMARY

Under direction, provides assessment, linkage and referrals to individuals seeking Macomb County Community Mental Health (MCCMH) services. Determines eligibility, severity and intensity of services needed and reviews authorization requests for services for utilization management purposes.


ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

Monitor and evaluate the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of the applicable laws, policies, procedures, and health benefit plans.


Processes electronic and telephonic level of care determinations; Processes electronic and telephonic authorization requests for ongoing services; processes electronic and telephonic requests for psychiatric hospitalization and other crisis services; make decisions related to medical necessity and the utilization of services.


Completes case documentation in accordance with MCCMH policies and procedures, including clinical records and statistical reports.


Performs direct clinical services, a majority of which are provided via telephonic interaction, including telephone screening of children, adolescents, and adults for the purpose of linking to MCCMH services; determining appropriate clinical levels of care; crisis intervention; and treatment interventions.


Maintains appropriate contact with providers, community agencies, and other service providers to coordinate consumer care and referrals, acts as liaison for consumer needs.


Participates in staff meetings, in-service trainings, and supervision with Clinical Supervisor.


Develops effective relationships with service providers.


Serves on Community Mental Health or community-based committees.


Participate in peer driven training of new staff and perform daily tasks in a team-orientated environment.


Maintains and updates clinical knowledge by completing in-services, trainings, and other activities determined in consultation with the agency’s annual plan and clinical supervisor or designee.

Must be available to work flexible hours and on call rotation as required.


Performs other duties as assigned.


QUALIFICATIONS

Required Education and Experience

  • Master’s Degree in Social Work, Counseling, Psychology or Doctorate in Psychology or a directly related mental health field from an accredited college or university
  • Two (2) years clinical experience working in a mental health setting

Preferred Education and Experience

  • Previous experience in utilization management
  • Knowledge of Macomb County Provider Network


Required Licenses or Certifications

  • Licensed Master Social Worker (LMSW), Limited Licensed Master of Social Work (LLMSW), Licensed Professional Counselor (LPC), Limited License Professional Counselor (LLPC), Temporary Limited Licensed Psychologist (TLLP), or Licensed Psychologist (LP)
  • Possession of required state licensure appropriate to position and ability to meet privileging and credentialing guidelines
  • Possession of a valid Michigan driver’s license and operable, insured automobile for authorized travel


Preferred Licenses or Certifications

Certification with the Michigan Certification Board for Addiction Professionals (MCBAP) or an approved development plan


COMPETENCIES FOR SUCCESSFUL PERFORMANCE OF JOB DUTIES

Knowledge of:

  • Resources within MCCMH and outside of Macomb County Community Mental Health
  • Michigan Mental Health Code/401 criteria
  • Mental illness, serious emotional disturbance, and developmental disabilities
  • Techniques to de-escalate/interact in potentially dangerous situations
  • Applicable computer applications


Skill in:

  • Using good professional judgment for the welfare and safety of our consumers
  • Providing excellent and timely customer service
  • Performing a variety of duties, often changing from one task to another


Ability to:

  • Collaborative: Approaches all situations with a teamwork and solution focused mindset demonstrated through active participation in meetings, volunteering to assist teammates and other departments as appropriate. Examples include participation in internal and external committees, subcommittees, process improvement groups or other multi-organizational initiatives Accountable: Takes ownership and empowers others to do the same as evidenced by identifying solutions and acting on job responsibilities and organizational objectives, daily Respectful: Treats people with dignity while honoring individual differences demonstrated through use of positive and encouraging statements and/or interactions to, about and/or with colleagues and persons served; evidenced by supervisor observation, feedback from other department staff and leadership Work in an environment which embraces the county’s Dignity Campaign
  • Effectively speak, write, and understand the English
  • Effectively speak, write, and understand a language other than English is preferred
  • Understand and carry out oral and/or written instructions
  • Accurately organize and maintain paper documents and electronic files
  • Maintain the confidentiality of information
  • Work independently

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