Member & Recipient Services Clinician (Sun-Wed, Remote NC)

LOCATION:  Remote – this is a home based, virtual position. This person must reside in North Carolina or within 40 miles of the NC border. 

Work Schedule:  Sunday - Wednesday from 10am-9pm. Due to the nature of the Call Center and the Behavioral Health Crisis line, the job may require some holiday work throughout the year.

GENERAL STATEMENT OF JOB

This position is within the Member and Recipient Services Department at Vaya Health. The Member and Recipient Services Clinician is responsible for providing an array of functions to assist consumers in receiving clinically appropriate assessments and services.  Telephone calls come to the unit via a 1-800 number from members, recipients,  families, agencies, organizations, professionals and others within Vaya's catchment area. The Behavioral Health Crisis service line operates 24 hours per day, seven days per week, 365 days per year and the employee is subject to working holidays and holiday rotation as deemed necessary by the business.

The primary purpose of the position is to provide telephone screening and triage for callers and families who are seeking mental health, substance abuse, or developmental disability services. The unit assesses the nature of the caller's situation, determines the urgency of the caller's need, and makes a referral to the most appropriate service available based on the caller's location and insurance plan. 

Duties include linking callers to needed services within clinically appropriate time frames, including telephonic clinical triage and referral which includes a determination of need for urgent or emergent services.  In addition to providing clinical support the position will also directly handle any telephonic requests for services at times of heavy call volume. 

The employee works productively and efficiently with a wide variety of consumers, families, agencies, professionals, law enforcement and others in the community. Callers may be in distress or in emergency or crisis situations requiring speedy assessment and intervention. Some callers are at risk to harm themselves or others and this risk must be accurately assessed. The high volume of calls requires the employee to balance the need to do a careful and accurate telephone assessment of the consumer's need and situation, with the need to be efficient in the use of time to complete the screening and triage interaction. The employee develops and maintains the knowledge and skills necessary to accurately assess and refer consumers from all disability areas, and also maintains a good working knowledge of resources available throughout Vaya's entire catchment area.

Note: This position requires access to and use of confidential healthcare information or protected health information (PHI) as described in laws addressing patient confidentiality, including, but not limited to, the federal HIPAA law, the Confidentiality of Alcohol and Substance Abuse Patient Records law, 42 CFR Part 2, and various state laws. As such, the individual filling this position shall be required to be trained regarding such laws and shall be required to observe those laws in his/her capacity as an employee of Vaya Health. The individual filling this position shall also sign a confidentiality statement as an employee of Vaya Health.

ESSENTIAL JOB FUNCTIONS

Handle telephonic requests for services, respond to member and recipient calls, and provide requested information:

Member and Recipient Svcs Clinician perform clinical screening, triage and referral to callers needing services, answer and provide disposition to service request calls at times of heavy call volume, and handle crisis calls in the Member and Recipient Services Call Center.  Member and Recipient Svcs Clinicians triage calls for urgency and facilitate access to crisis services when risk indicators are present. Where safety is at risk, the employee initiates immediate intervention via law enforcement or emergency medical assistance. Member and Recipient Svcs Clinicians will provide information and educate callers about the involuntary commitment process, as appropriate based on assessment of risk.

The employee provides brief crisis interventions and/or support when indicated to facilitate the assessment process, encourages compliance, addresses safety issues, etc. Clinical functions are performed by the Member and Recipient Services Clinicians.

Member & Recipient Svcs Clinician will inquire about the caller's needs, determine clinical urgency, review and confirm member and recipient eligibility, collect necessary demographic information, offer choice of available providers based upon the consumers request and service needs, and schedule appointments within established access time standards.

The Member & Recipient Svcs Clinician will inform a Member Services Manager and/or appropriate Network Development staff of gaps and needs associated with trends that are detected within the services system for timely analysis and resolution.

For information calls, this position will provide information about Vaya, the Vaya provider network, community resources, and about Medicaid services in the State of NC. Member & Recipient Svcs Clinician shall receive extensive training on customer services skills such as the use of appropriate tone, cadence, inflection, and choice of recovery oriented and/or person-centered wording. All Member and Recipient Services Representatives must adhere to NCMT Call Grading Rubric provided by NCDHHS.

This position requires a high degree of communication skills and professionalism with various parties- members, recipients, providers, vendors, community organizations, legal guardians, and more.  The Member and Recipient Svcs Clinician will complete warm transfers and linkages to a variety of different parties to assist the caller with correct linkage.

Documentation in the electronic information system:

The Member & Recipient Svcs Clinician completes call notes, forms, reports and other documentation as required. The Member and Recipient Services Clinician will complete required documentation at the time of call. This position requires a high degree of technical skills with utilization of multiple systems/logins throughout a phone call.

Specialized projects and reviews:

The Member & Recipient Svcs Clinician will assist in specialized Member Services Departmental projects as requested by the Member and Recipient Services Managers or Directors, and/or the Vice President of Member and Recipient Services.

Other duties as assigned.

KNOWLEDGE, SKILLS, & ABILITIES

• A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance. This will require exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts.  Problem solving, negotiation, arbitration and conflict resolution skills are essential to balance the needs of both internal and external customers.
• Mastery of utilization review principles to resume continuity of care and clinical evaluations as needed for appropriate provision of intensive, crisis services and other levels of care to ensure linkage to correct services; 
• Knowledge of documentation and clinical protocols for utilization purposes.
• Knowledge of linage, authorization and level of care determinations, assisting providers     with creative problem solving to suggest alternative approaches to care.
• Clinical knowledge of managed systems of mental health and substance abuse.  Knowledge of managed behavioral care practices.
• Ability to collaborate with providers and other agencies.
• Clinical knowledge of mental health and substance abuse treatment as a basis for clinical triage and referral decisions 
• Comprehensive knowledge of resources and the ability to use a personal workstation.

Knowledge of databases and data entry is essential.  A degree alone does not prepare an applicant for this position.  Experience providing mental health, substance abuse, or intellectual/ developmental disabilities services are essential.  This employee should have knowledge of individual and group dynamics, and will learn de-escalation of telephonic situations, and a thorough knowledge risk indicators.  Considerable knowledge of governmental and private organizations and resources in the community is beneficial.  Considerable knowledge of the laws, regulations, and policies that govern MCO  operations is beneficial.  Skill in establishing rapport with staff/consumers in discussing their issues in a sensitive, supportive and nonjudgmental way is necessary.  Ability to establish and maintain effective working relationships with community members and provider agency staff is necessary.

Other skills or abilities require are as follows:

• Knowledge of behavioral health principles, techniques, and practices, and their applications to complex treatment and service provision.
• Considerable knowledge of person-centered and recovery philosophies.
• Familiarity with mental health, developmental disability and substance abuse disorders.
• The ability to remain professionally responsive in an ethical and sensitive manner to individual's needs throughout the course of the work day/shift.
• The ability to work responsibility and effectively with others for a timely resolution of the caller's needs.
• The ability to interact professionally and effectively with persons who are upset and who disagree.
• Knowledge of the laws, regulations, and policies which govern human services and utilization management.
• The ability to express ideas clearly and concisely orally and in writing, and to plan and execute work effectively and efficiently.
• The ability to utilize complex telephone and computer systems, and to read and document information electronically.

EDUCATION & EXPERIENCE REQUIREMENTS

Master's degree in a Human Services field (such as Psychology, Social Work, etc.) and at least two (2) years of post-degree-progressive experience providing services in the population served OR graduation from a State accredited school of nursing and two years of experience in psychiatric nursing which provides the knowledge, skills, and abilities needed to perform the work; or an equivalent combination of education and experience.

Must possess a current and valid professional license or certificate in North Carolina; or possess a current and valid license or certificate from another state or be certified by the national accrediting body appropriate to their profession. (URAC HCC 5)

Experience in the public mental health field and a thorough understanding of the services available in the catchment area is highly desired due to the complexity of the work of the organization.  Prior experience in a Call Center environment in Behavioral Healthcare would be valuable for this employee.

A degree alone does not prepare an applicant for this position.  Experience providing mental health or substance abuse services are essential.

No experience can be substituted for the formal degree.

Licensure/Certification Required: 

Must possess a current, active, unrestricted professional license or certification from North Carolina in a Human Services field (such as Psychology, Social Work, Counseling, Marriage and Family Therapy, Addictions, etc.). Acceptable licenses include Licensed Clinical Social Worker (LCSW), Licensed Clinical Mental Health Counselor (LCMHC), Licensed Clinical Addictions Specialist (LCAS), Doctor of Psychology (Psy. D.), PhD. Psychologist, Licensed Marriage and Family Therapist (LMFT) or Licensed Psychological Associate (LPA). For RN candidates, the employee must have a current, active, unrestricted professional license to practice as a registered Nurse in North Carolina by the NC Board of Nursing.

PHYSICAL REQUIREMENTS

• Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading. 
• Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers. 
• Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time. 

RESIDENCY REQUIREMENT:  The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border.

SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation. 

DEADLINE FOR APPLICATION: Open Until Filled

APPLY: Vaya Health accepts online applications in our Career Center, please visit 

Vaya Health is an equal opportunity employer.

WORK SCHEDULE: Sunday -Wednesday from 10am-9pm. Due to the nature of the Call Center and the Behavioral Health Crisis line, the job may require some holiday work throughout the year.

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