Clinical Specialist - Performance Improvement

Under the general supervision of the Director of Quality Management, the Clinical Specialist Performance Improvement is responsible for ensuring compliance of assigned providers to federal, state, local, contractual, regulatory and best practices standards and guidelines.


PRINCIPAL DUTIES AND RESPONSIBILITIES :

• Conducts reviews of Critical/Sentinel Events to determine if the incident meets the criteria and definitions for a critical event, critical incidents, risk events, sentinel event, or media events and is related to a practice or standard of care.
• Classifies a critical event or incident as either a) sentinel event, or b) non-sentinel event.
• Develops and updates the "MH-WIN Procedural Guidance Manual for Reporting Critical Incidents/Events, Sentinel Events and Death Reporting Process".
• Documents and reports high profile, media-reported and urgent incidents that meet the critical incident criteria.
• Develops Critical/Sentinel event face-to-face trainings for the provider network for accessing the Critical/Sentinel Event Module.
• Reports ALL deaths (expected and unexpected) along with the appropriate information to MDHSS within 24 hours of knowledge.
• Processes the closure of assigned deaths in the MH-WIN Module.
• Provides oversight and management of Performance Improvement Projects.
• Reviews investigations of records and information concerning the member including, but not limited to, the review of Individual Plans of Service (IPOS), progress notes, psychiatric evaluations, Behavior Management Plans, records of dispute resolutions, grievances and appeals, and recipient rights complaints.
• Provides follow-up with providers for completion of root cause analysis or investigation; a) the findings shall include actions that will minimize the further occurrence of the sentinel event (per CMS approval and MDHHS current contractual requirement); or b) a written explanation providing the rational for not pursuing an intervention. A corrective action plan or intervention must identify: objective, measurable actions; who will implement the plan of action; a timeframe for the implementation; and how the implementation of the plan will be monitored or evaluated and submitted to DWIHN.
• Maintains all materials as confidential and distributes only as necessary to perform the peer review function.
• Ensures that all information related to the Critical Event is uploaded in MH-WIN using the Critical Event/Sentinel Event Module and placed into the "All Scanned Documents" tab.
• Reviews Critical and Sentinel Events to include analysis and reporting of member experience and satisfaction with services provided allowing for integration with the Customer Experience process.
• Works with the QI Administrator and Director to develop performance improvement targets for quality, service, and efficiency of the organization.
• Implements changes targeted as systems improvement.
• Measures and evaluates attainment of results.
• Collaborates with other DWIHN units to ensure communication, teamwork and integration to support achievement of desired improvements.
• Performs related duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of DWIHN policies, procedures and practices.
• Knowledge of the principals of quality improvement.
• Knowledge of Utilization Management.
• Knowledge of Critical/Sentinel Event policies and procedures.
• Knowledge of Quality Assurance.

• Knowledge of accreditation and certification standards related to the provision of mental health, developmental disability and substance use disorder services.

• Knowledge of the DWIHN provider network.
• Knowledge of medical and behavioral health practices and terminology.
• Knowledge of compliance standards.
• Knowledge of the Medicaid screening process.
• Knowledge of MDHHS policies, rules, regulations and procedures.
• Computer skills
• Time management skills
• Organizational skills
• Critical thinking skills
• Teamwork skills.
• Conflict Resolution skills
• Decision Making skills
• Project Management skills
• Assessment skills.
• Report writing skills.
• Communication skills.
• Multitasking skills.
• Analytical 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, the Human Services, the Social Services or a related field.

REQUIRED EXPERIENCE:

Three (3) years of professional experience in behavioral healthcare including at least (2) two years of experience in a community mental health setting and two years of experience in clinical practice.

REQUIRED LICENSE(S):

• A Valid State of Michigan clinical licensure: LMSW, LPC, LLP
• Must meet credentialing qualification in at least one of the following: Qualified Mental Health Professional (QMHP), Qualified Intellectual Disabilities Professional (QIDP), Qualified Children Mental Health Professional (QCMHP)
• A valid State of Michigan Driver's License with a safe and acceptable driving record.

WORKING CONDITIONS :

Work is usually performed in an office setting but requires the employee to drive to different sites throughout Wayne County and the State of Michigan. This position can work remotely with supervisory approval. Currently this position is primarily a remote position.

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