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Telephonic Clinical Assessment Specialist
2 months ago
Under the general oversight of the Call Center Administrator, the Call Center Clinical Specialists are tasked with conducting telephonic clinical evaluations and assessments to ascertain eligibility for the public mental health system, ensuring that clients receive the appropriate level of care.
KEY RESPONSIBILITIES:
- Assess appropriate levels of care for referrals, guiding clients in choosing suitable service providers.
- Initiate referrals to selected service providers.
- Facilitate re-authorization of Substance Use Disorder (SUD), Mental Health, and co-occurring services.
- Support providers with additional client information to ensure suitable treatment referrals.
- Evaluate clinical suitability for clients.
- Apply priority status criteria for placement.
- Conduct follow-ups with clients admitted for treatment to support a continuum of care.
- Monitor client compliance with services and assist with aftercare and recovery planning.
- Review requests for authorizing and reauthorizing medically necessary services and lengths of stay.
- Manage client care through the MH-WIN system.
Provide community callers with information about local resources and assist them in accessing community services. Utilize technology to perform both clinical and administrative tasks effectively. Ensure that clients are authorized for interventions that meet medical necessity and are the least restrictive options available. Collaborate with providers, health home teams, and community organizations.
Propose innovative and alternative Care Plans when progress is stagnant. Actively participate in program improvements and quality improvement initiatives. Conduct data collection, documentation, and analysis. Apply Medical Necessity Criteria for Behavioral Health services and relevant standardized assessments. Perform initial and ongoing evaluations of enrollees' clinical conditions, both behavioral and physical.
Communicate with medical and behavioral health providers regarding treatment planning and the clinical and psychosocial needs of clients. Ensure that the reauthorizations database is consistently updated to reflect the current status of individuals in treatment. Track and monitor cost factors related to service utilization, treatment activities, and other access and placement criteria. Enter data and reports into both written formats and electronic databases.
Monitor provider services for compliance with Federal, State, and Medicaid admission requirements. Identify trends at the provider and network levels and submit recommendations for clinical training or technical support. Review behavioral assessments, diagnostic reports, and treatment plans to evaluate the appropriateness of authorization requests. Perform related duties as assigned.
EDUCATIONAL REQUIREMENTS:
A Master's Degree in Social Work, Psychology, Counseling, Nursing (a Bachelor's Degree will be accepted), Human Services, Social Services, or a related field.
EXPERIENCE REQUIREMENTS:
Three (3) years of professional clinical experience in behavioral healthcare or a community mental health environment.
LICENSE REQUIREMENTS:
A Valid State of Michigan clinical license: RN, LMSW, LMHC, LPC, LLP, or PhD. A valid State of Michigan Driver's License with a safe and acceptable driving record.
Working Conditions: Part-Time staff may work remotely with management approval.
This description is intended to provide a general overview of the essential functions performed and is not a complete statement of job content. Management retains the discretion to modify the position at any time.
IMPORTANT NOTE:
The Detroit Wayne Integrated Health Network requires proof of full COVID-19 vaccination as a condition of employment. Medical or religious accommodations or other exemptions may be granted as required by law, and further information will be provided during the recruitment process. The Detroit Wayne Integrated Health Network is an Equal Opportunity Employer.
