Clinical Specialist Performance Monitor

Job Description

Job Description

CLINICAL SPECIALIST - PERFORMANCE MONITOR

Under the general supervision of the Quality Administrator, Performance Monitoring, the Performance Monitor staff is responsible for conducting on-site reviews of providers and ensuring their compliance with quality and performance standards among contracted Substance Use Disorder (SUD) treatment providers. This role emphasizes monitoring provider adherence to regulatory requirements, contractual obligations, and evidence-based practices to improve outcomes for individuals receiving SUD services.

PRINCIPAL DUTIES AND RESPONSIBILITIES :

• Monitor SUD provides compliance with state, federal, and organizational regulations.
• Review provider documentation, billing practices, and service delivery for accuracy and integrity.
• Conduct audits and site visits as required.
• Track provider performance metrics, including treatment outcomes, timeliness, and member satisfaction.
• Identify gaps in service quality and collaborate with providers to implement corrective action plans.
• Ensure adherence to evidence-based treatment protocols
• Collect and analyze data related to provider performance and compliance.
• Prepare reports for leadership summarizing findings, trends, and recommendations.
• Maintain accurate records of monitoring activities.
• Serve as a liaison between providers and internal departments to resolve issues.
• Provide technical assistance and training to providers on compliance and quality standards.
• Support continuous improvement initiatives across the SUD provider network.
• Designs systems and procedures.
• Conducts work simplification and measurement studies.
• Prepares operations and procedures manuals.
• Sets standards, conducts performance assessments, and conducts remote and on-site monitoring of providers in the network.
• Monitors the facility quality improvement process and provides facility provider education and oversight.
• Participate in MDHHS audits and site visits.
• Oversee new program enrollment and Medicaid Enrollment reviews, which involve site visits to ensure that new programs or programs requiring Medicaid enrollment meet the minimum requirements for participation in the DWIHN network.
• Attend SUD and other provider meetings.
• Reviews data for trends and creates monthly reporting, including reporting data into the Cascade software database.
• Communicate with providers by responding to phone calls, responding to e-mail requests, providing training, and providing technical assistance.
• Performs related duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES

• Knowledge of DWIHN policies, procedures, and practices.
• Knowledge of the principles of quality improvement.
• Knowledge of Utilization Management
• Knowledge of Quality Assurance.
• Knowledge of the DWIHN provider network.
• Knowledge of medical, behavioral health, and SUD practices and terminology.
• Knowledge of compliance standards.
• Knowledge of the evidence-based practices for prevention, treatment, and recovery support services for mental and substance use disorders.
• Knowledge of MDHHS policies, rules, regulations, and procedures.
• Knowledge of Medicaid policies, rules, regulations, and procedures.
• Knowledge of the NCQA accreditation process.
• Knowledge of HSAG annual compliance reviews.
• Knowledge of Integrated Care principles and practices.
• Knowledge of Health and Safety and Claims Investigations.
• Knowledge of Behavior Treatment Plans, IPOS, Medication Administration, and Incident reporting.
• Assessment skills.
• Organizational skills.
• Planning skills.
• Analytical skills.
• Report writing skills.
• Decision-making skills.
• Interpersonal skills.
• Communication skills
• Teaching skills.
• Training skills.
• Coordination skills
• Written communication skills
• Investigation skills.
• Computer skills (Word, Excel, Access, Power Point, Outlook, Teams).
• Teamwork 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.
• Judgement/Reasoning ability.

REQUIRED EDUCATION:

A master’s degree in social work, Psychology, Counseling, Nursing (a bachelor’s degree will be accepted), or a related field.

Licensure/Certification:

State of Michigan license commensurate with Degree (LLMSW, LMSW, LLP, LP, LLPC, LPC, RN) MCBAP Certification: CAACD, CADC, CPS, or CPC

Must meet credentialing qualifications in at least one of the following: Qualified Mental Health Professional (QMHP), Qualified Intellectual Disabilities Professional (QIDP), Qualified Children Mental Health Professional (QCMHP), or Substance Abuse Treatment Specialist (SATS).

A valid State of Michigan Driver’s License with a safe and acceptable driving record.

REQUIRED EXPERIENCE:

Four (4) years of professional experience in a behavioral healthcare or a community mental health setting, including at least 2 two years of experience performing clinical duties and responsibilities, prevention, treatment, or recovery support services for mental and substance use disorders.

WORKING CONDITIONS :

Work is typically conducted in an office environment, but it requires the employee to drive to various sites throughout Wayne County and the State of Michigan. This position is Hybrid and allows for remote work with supervisory approval when necessary.

This description is not intended to be a complete statement of job content, rather to act as 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