Call Center Clinical Specialist

Call Center Clinical Specialist

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:

• Determines appropriate levels of care for referral, assisting clients in selecting appropriate service providers.
• Initiates referrals to selected providers.
• Provides re-authorization of SUD/Mental Health/co-occurring services.
• Assists providers with additional client information to provide appropriate referral for treatment services.
• Evaluates clinical appropriateness for consumers.
• Establishes funding eligibility.
• Applies priority status criteria for placement.
• Conducts follow-up with clients who were admitted for treatment to assist them with a continuum of care.
• Monitors client's compliance with services and assists with aftercare/recovery plan services.
• Reviews requests for authorizing/reauthorizing medically appropriate services and length of stay.
• Manages client care through the MH-WIN system.
• Provides community callers with information related to community resources and assists callers with information on how to access community services.
• Utilizes computer to perform clinical and administrative job functions.
• Ensures that consumers are authorized for interventions that meet medical necessity and are least restrictive.
• Works collaboratively with providers, health home teams, and community agencies.
• Proposes alternative and creative Care Plans when progress is stalled.
• Participates actively in program enhancements and the QI program.
• Conducts data gathering, documentation and analysis.
• Applies Medical Necessity Criteria for Behavioral Health services and applicable standardized assessments, i.e., Level of Care Utilization of System (LOCUS), Supports Intensity Scale (SIS), American Society of Addiction Medicine Patient Placement Criteria (ASAM), Autism Diagnostic Observation Scale Second Edition (ADOS-2), Autism Diagnostic Interview - Revised (ADI-R), Developmental Disabilities - Clinical Global Impression Severity Scale (DD-CGAS), as well as other medical necessity tools and the Federal Confidentiality Regulations, 42 CFR, Part 2.
• Conducts initial and ongoing review of enrollee's clinical condition both behavioral and physical.
• Communicates with medical and behavioral providers regarding treatment planning.
• Communicates with medical and behavioral providers regarding clinical and psychosocial needs.
• Ensures that the reauthorizations database is continuously updated and reflects the current status of individuals in treatment.
• Tracks and monitors cost factors relative to service utilization, treatment activities, and other access and placement criteria.
• Enters data and reports into written formats and electronic databases.
• Monitors provider services for adherence to priority Federal, State and Medicaid admission requirements.
• Identifies trends at the provider and network level and submit suggestions for clinical training and or technical support.
• Reviews behavioral assessments, diagnostic reports and treatment plans to assess the appropriateness of the authorization request.
• Performs related duties as assigned.

Knowledge, Skills and Abilities (KSA's)

• 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, e.g., Medicaid Manual Mental Health and Substance Abuse Chapter III, State Plan for Medicaid, Michigan Department of Health and Human Services Quality Plan, BBA requirements and the Mental Health Code.
• 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.
• Knowledge of the practices and principles of psychological, emotional, and sociological assessment and diagnosis.
• 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.
• 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 License(s):

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:

This is currently not a remote position.

Note: The DWIHN Call Center is a 24/7 operation. Employees in the Call Center may be required to work one of three shifts (Days, Afternoons, Midnights) and weekends.

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

Detroit Wayne Integrated Health Network