Under the general supervision of the Call Center Administrator, the Call Center Clinical Specialists are responsible for completing telephonic clinical screenings and assessments to determine eligibility into the public mental health system so that consumers will receive the appropriate level of care.
Principal duties and responsibilities include determining appropriate levels of care for referral, assisting clients in selecting appropriate service providers, initiating referrals to selected providers, providing re-authorization of SUD/Mental Health/co-occurring services, assisting providers with additional client information to provide appropriate referral for treatment services, evaluating clinical appropriateness for consumers, establishing funding eligibility, applying priority status criteria for placement, conducting follow-up with clients who were admitted for treatment to assist them with a continuum of care, monitoring client's compliance with services and assisting with aftercare/recovery plan services, reviewing requests for authorizing/reauthorizing medically appropriate services and length of stay, managing client care through the MH-WIN system, providing community callers with information related to community resources and assisting callers with information on how to access community services, utilizing computer to perform clinical and administrative job functions, ensuring that consumers are authorized for interventions that meet medical necessity and are least restrictive, working collaboratively with providers, health home teams, and community agencies, proposing alternative and creative Care Plans when progress is stalled, participating actively in program enhancements and the QI program, conducting data gathering, documentation and analysis, applying Medical Necessity Criteria for Behavioral Health services and applicable standardized assessments, conducting initial and ongoing review of enrollee's clinical condition both behavioral and physical, communicating with medical and behavioral providers regarding treatment planning, communicating with medical and behavioral providers regarding clinical and psychosocial needs, ensuring that the reauthorizations database is continuously updated and reflects the current status of individuals in treatment, tracking and monitoring cost factors relative to service utilization, treatment activities, and other access and placement criteria, entering data and reports into written formats and electronic databases, monitoring provider services for adherence to priority Federal, State and Medicaid admission requirements, identifying trends at the provider and network level and submitting suggestions for clinical training and or technical support, reviewing behavioral assessments, diagnostic reports and treatment plans to assess the appropriateness of the authorization request, and performing related duties as assigned.
Knowledge, skills and abilities (KSA's) include knowledge of DWIHN policies, procedures and operations, knowledge of the DWIHN provider network, knowledge of medical and behavioral health practices and terminology, knowledge of MDHHS policies, rules, regulations and procedures, knowledge of Call Center Operations, knowledge of Customer Service practices and principals, knowledge of co-occurring and substance use treatment services, knowledge of the American Society of Addiction Medicine Patient Placement Criteria (ASAM) and the Federal Confidentiality Regulations, 42 CFR, Part 2, knowledge of SUD Policies and Procedures, knowledge of various treatment modalities including Opiate Maintenance Treatment (OMT) (and re-authorization of Medication Assisted Treatment (MAT) criteria), case management, chemically-dependent pregnant women, co-occurring individuals, SMI/SED and I/DD populations, knowledge of women specialty services requirements, knowledge of priority population admittance, knowledge of State Disability Assistance (SDA), knowledge of Intravenous Drug User (IDU) management, knowledge of and ability to use screening and assessment tools for behavioral health services, knowledge of and ability to use treatment planning, case management and continuing care for behavioral health services, knowledge of documents / regulations that govern the provision of mental health services, knowledge of the practices and principles of psychological, emotional, and sociological assessment and diagnosis, knowledge of diagnostics, psychopharmacology, and supportive treatment approaches as applied to a severely mentally ill (SMI) adult population, knowledge of the identification and treatment of co-occurring mental health and substance use disorders, knowledgeable of psychotropic medications, knowledge of Pre-Admission Review (PAR) Screening, computer skills, time management skills, organizational skills, critical thinking skills, decision making skills, customer service skills, language skills, listening skills, relationship building skills, teamwork skills, training skills, ability to communicate orally, ability to communicate in writing, ability to work effectively with others, ability to work with an ethnically, linguistically, culturally, economically and socially diverse population, and judgement/reasoning ability.
Required education: A Master's Degree in Social Work, Psychology, Counseling, Nursing (a Bachelor's Degree will be accepted), the Human Services, the Social Services or a related field.
Required experience: Three (3) years of professional clinical experience in behavioral healthcare or a community mental health setting.
Required licenses: A Valid State of Michigan clinical licensure: RN, LMSW, LMHC, LPC, LLP or PhD. A valid State of Michigan Driver's License with a safe and acceptable driving record.
Working conditions: Contingent staff are allowed to work remotely with management approval.
This description is not intended to be a complete statement of job content, rather to act as a general description of the essential functions performed. Management retains the discretion to add or change the position at any time.
Please note: DWIHN requires proof of being fully vaccinated for COVID-19 as a condition of employment. Medical or religious accommodations or other exemptions that may be required by law, will be approved when properly supported. Further information will be provided during the recruitment process.
The Detroit Wayne Integrated Health Network is an Equal Opportunity Employer
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