Complex Case Coordinator
3 weeks ago
COMPLEX CASE COORDINATOR
Under the general supervision of the Clinical Specialist-Complex Case Management and the Director of Integrated Health, the PIHP Complex Case Manager monitors and manages care coordination initiatives. This position also helps to guide DWIHN, its provider network and the healthcare community in progressing toward a holistic, integrated and broad ranged service model.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Monitors and manages care coordination initiatives.
Assists DWIHN, its provider network and the healthcare community in progressing toward a holistic, integrated and broad ranged service model.
Follows NCQA guidelines for Complex Case Management.
Maintains a caseload of DWIHN members.
Visits DWIHN members in the hospital or community settings.
Completes assessments and plans of care within the required time frames.
Identifies eligible members through various sources i.e., Hospital inpatient lists, EMS lists, PHQ, Hospital Recidivism, etc..
Oversees marketing and education of Wayne County Community Providers.
Receives and responds to complex case management referrals in the designated time frames.
Completes weekly and monthly reports
Provides transitions of care support for DWIHN members who are discharged from acute care settings.
Maintains a compiled list/data of members for reporting requirements.
Coordinates with member care teams at the community level.
Connects members with community resources and health providers.
Assists members with applying for health benefits, SSI, bridge card etc..
Participates in care review mock audits and file reviews.
Provides care coordination for members who are not eligible for Complex Case Management.
Attends weekly team meetings, all staff meetings and other DWIHN meetings as necessary.
Attends CRSP, COPE, Children, Hospital Liaison meetings as designated.
Attends DWIHN training courses and any other training as required.
Performs related duties as assigned.
KNOWLEDGES, SKILLS AND ABILITIES (KSA'S)
Knowledge of DWIHN policies, procedures and practices.
Knowledge of the DWIHN provider network and community resources.
Knowledge of the Michigan Mental Health Code.
Knowledge of MDHHS policies, rules, regulations and procedures.
Knowledge of Federal policies, rules, regulations and procedures as it relates to DWIHN.
Knowledge of MHWIN
Knowledge of the LOCUS model.
Knowledge of the clinical care process (screening, assessment, treatment planning, case management, and continuing care).
Knowledge of the Adult continuum of care for all disability designations (I/DD, SMI, Co-Occurring Disorder).
Knowledge of adult services: Outpatient, Co-Occurring services, CM, ACT, Supported Employment, Supports Coordination and Med Drop.
Knowledge of Integrated Care services for behavioral health patients
Knowledge of Medicaid, local, regional and national codes, laws and regulations.
Knowledge of Medical Necessity Criteria and Service Utilization Guidelines for Behavioral Health Services.
Knowledge of the American Society of Addiction Medicine Patient Placement Criteria (ASAM).
Knowledge of resources for each level of care of admission ranging from inpatient to outpatient and including substance use.
Knowledge of regulatory and industry best practice standards.
Knowledge of Community Mental Health Services Programs (CMHSP) and Prepaid Inpatient Health Plans (PIHP).
Knowledge of Integrated Care methodology, practice and implementation.
Knowledge of the DSM-V Statistical Manual
Knowledge of
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